Pancho - RAM-SUS-84

Code: RAM-SUS-84
Mercy ID: V-02996-01
Encounter Date: 02/03/2009
Last: Ramirez
First: Susana
DOB: 06/09/1984
County: Gwinnett
Street: 202 Club Parkway
City: Norcross
State: GA

Zip

30093-

Cell

(708) 983-8524

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

Grade 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: J. Perez
Data Entry: J. Manzo