Pancho - LOZ-ROM-82

Code: LOZ-ROM-82
Mercy ID: V-02096-01
Encounter Date: 10/13/2005
Last: Lozano
First: Romina
DOB: 11/04/1982
County: Fulton
Street: No sabe
City: Lilburn
State: GA

Zip

30340-

Cell

(678) 851-8056

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Transitional

Education Level

Grade 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: 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