Pancho - FON-GLO-62

Code: FON-GLO-62
Mercy ID: V-02345-01
Encounter Date: 10/30/2006
Last: Fonseca
First: Gloria
DOB: 01/03/1962
County: Cobb
Street: 1550 Bell Ferry Rd.
City: Marietta
State: GA

Zip

30066-

Home

(678) 354-2680

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

some high school

Home Owner

YES

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: J. Perez
Data Entry: J. Manzo