Pancho - SAN-ERI-82

Code: SAN-ERI-82
Mercy ID: V-02187-01
Encounter Date: 03/01/2006
Last: Sandoval
First: Erica
DOB: 04/23/1982
County: Gwinnett
Street: 3768 Elmside Dr. # B
City: Norcross
State: GA

Zip

30092-

Home

(678) 577-1865

Cell

(678) 668-5960

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Single Family

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