Pancho - MAG-VER-67

Code: MAG-VER-67
Mercy ID: V-02466-01
Encounter Date: 04/16/2007
Last: Magallanes
First: Veronica
DOB: 10/03/1967
County: Gwinnett
Street: 4305 Paxton Lane
City: Lilburn
State: GA

Zip

30047-

Cell

(678) 754-7576

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

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: J. Manzo