Pancho - GAL-NAT-79

Code: GAL-NAT-79
Mercy ID: V-02087-01
Encounter Date: 11/04/2005
Last: Gallegos
First: Natali
DOB: 04/07/1979
County: Douglass
Street: not given
City: Canton
State: GA

Zip

30155-

Home

(770) 489-7145

Family Status

Single parent w/children

COB

Ecuador

Gender

Female

Housing

Not Homeless

Education Level

Other

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: G. Landeros
Data Entry: R. Gonzalez