Pancho - ROS-PAT-60

Code: ROS-PAT-60
Mercy ID: V-02714-01
Encounter Date: 02/15/2008
Last: Rosenfeld
First: Patricia
DOB: 01/13/1960
County: Other
Street: 999 no lo sabe
City: West palm beach
State: FL

Zip

99999-

Cell

(678) 913-6939

Family Status

Adult couple-no children

COB

Colombia

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