Pancho - GUI-FUL-77

Code: GUI-FUL-77
Mercy ID: V-02678-01
Encounter Date: 07/11/2008
Last: Guillen
First: Fulgencia
DOB: 08/12/1977
County: Clayton
Street: 276 Upperriverdale Road # 11 C
City: Jonesboro
State: GA

Zip

30236-

Cell

(678) 437-5442

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Single Family

Education Level

some high 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