Pancho - RIC-DIA-60

Code: RIC-DIA-60
Mercy ID: V-03052-01
Encounter Date: 04/08/2009
Last: Rico
First: Diana
DOB: 10/13/1960
County: Gwinnett
Street: 999 Shelter
City: Lawrenceville
State: GA

Zip

99999-

Cell

(404) 749-8672

Family Status

Single adult

COB

Colombia

Gender

Female

Housing

Shelter

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: YES
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: G. Landeros
Data Entry: J. Manzo