Pancho - GUZ-BER-59

Code: GUZ-BER-59
Mercy ID: V-02004-01
Encounter Date: 08/10/2005
Last: Guzman
First: Berta
DOB: 08/10/1959
County: Cobb
Street: 3301 Lancer DR.
City: Powder springs
State: GA

Zip

30127-

Home

(770) 943-5658

Family Status

Single adult

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

some high school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	N/A	N/A	N/A
Father	N/A	N/A	N/A
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: N/A
Name of School: N/A
Grade: N/A
Who Can't Pickup the Child
Authoritation Parent: No
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: J. Perez
Data Entry: K. Aleman