Pancho - POL-DOR-65

Code: POL-DOR-65
Mercy ID: V-02152-01
Encounter Date: 01/23/2006
Last: Polanco
First: Dora
DOB: 11/26/1965
County: Gwinnett
Street: 1796 Ridge Dale dr
City: Snellville
State: GA

Zip

30078-

Home

(770) 972-5392

Cell

(404) 488-4317

Family Status

Two parent family w/children

COB

Costa Rica

Gender

Female

Housing

Not Homeless

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: 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