Pancho - REY-EVA-75

Code: REY-EVA-75
Mercy ID: V-02902-01
Encounter Date: 09/16/2008
Last: Reyes
First: Evangelina
DOB: 11/10/1975
County: Rockdale
Street: 721 Jefferson Drive
City: Conyers
State: GA

Zip

30094-

Home

(770) 922-3801

Cell

(678) 431-4939

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Single Family

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