Pancho - MED-BLA-74

Code: MED-BLA-74
Mercy ID: V-02820-01
Encounter Date: 06/16/2008
Last: Medrano
First: Blanca
DOB: 04/27/1974
County: Gwinnett
Street: 171 Paper Mill Road
City: Lawrenceville
State: GA

Zip

30045-

Home

(770) 995-5814

Cell

(678) 517-4041

Family Status

Single parent w/children

COB

El Salvador

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