Pancho - DEL-PEN-69

Code: DEL-PEN-69
Mercy ID: V-02378-01
Encounter Date: 12/29/2006
Last: De la o torres
First: Penelope
DOB: 11/26/1969
County: Gwinnett
Street: 724 Jackson Mill Way NW
City: Lilburn
State: GA

Zip

30047-

Home

(770) 807-6677

Cell

(404) 549-1612

Family Status

Two parent family w/children

COB

USA

Gender

Female

Housing

Single Family

Education Level

H.S. equivalency diploma

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: J. Manzo