Pancho - MEN-ORT-77

Code: MEN-ORT-77
Mercy ID: V-02277-01
Encounter Date: 05/23/2006
Last: Mendez
First: Hortencia
DOB: 01/11/1977
County: Gwinnett
Street: 1120 Forest Valley
City: Norcross
State: GA

Zip

00000-

Home

(770) 935-5227

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

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