Pancho - MAS-CRI-82

Code: MAS-CRI-82
Mercy ID: V-02113-01
Encounter Date: 10/29/2005
Last: Masterson
First: Crystal
DOB: 06/07/1982
County: Gwinnett
Street: 2906 Spruce Circle
City: Snellville
State: GA

Zip

30045-

Home

(678) 368-5553

Cell

(678) 760-2813

Family Status

Two parent family w/children

COB

USA

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: G. Landeros
Data Entry: R. Gonzalez