Pancho - ORT-BIB-73

Code: ORT-BIB-73
Mercy ID: V-02944-01
Encounter Date: 11/17/2008
Last: Ortiz
First: Bibiana
DOB: 03/09/1973
County: Gwinnett
Street: 1305 Sugarwood Ln.
City: Norcross
State: GA

Zip

30093-

Cell

(404) 824-0390

Family Status

Two parent family w/children

COB

Colombia

Gender

Female

Housing

Single Family

Education Level

Post Grad 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: C. Collier