Pancho - POR-SAN-68

Code: POR-SAN-68
Mercy ID: V-02710-01
Encounter Date: 02/12/2008
Last: Portillo
First: Sandra
DOB: 01/31/1968
County: Hall
Street: 999 no lo quiso dar
City: Gainesville
State: GA

Zip

30501-

Cell

(678) 849-8475

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

College Degree

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