Pancho - AVA-SUS-73

Code: AVA-SUS-73
Mercy ID: V-02636-01
Encounter Date: 10/25/2007
Last: Avalos
First: Susana
DOB: 08/19/1973
County: Gwinnett
Street: 78 Regal Way
City: Lawrenceville
State: GA

Zip

30044-

Cell

(678) 663-4261

Family Status

Single parent w/children

COB

El Salvador

Gender

Female

Housing

Doubling Up

Education Level

Some College

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