Pancho - POT-TAN-65

Code: POT-TAN-65
Mercy ID: V-02084-01
Encounter Date: 11/09/2005
Last: Potra
First: Tania
DOB: 07/21/1965
County: Gwinnett
Street: 900 Legacipara Dr #1316
City: Lawrenceville
State: GA

Zip

30043-

Home

(770) 403-1678

Family Status

Single adult

COB

Ecuador

Gender

Female

Housing

Transitional

Education Level

High school graduate

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: YES
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: G. Landeros
Data Entry: R. Gonzalez