Pancho - VIT-ROS-76

Code: VIT-ROS-76
Mercy ID: V-02514-01
Encounter Date: 06/06/2007
Last: Vital
First: Roseli
DOB: 11/11/1976
County: Dekalb
Street: 1412 Druid Valley Dr. Apt. B
City: Atlanta
State: GA

Zip

30329-

Home

(404) 671-7045

Family Status

Adult couple-no 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: 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