Pancho - GOM-ADE-60

Code: GOM-ADE-60
Mercy ID: V-03079-01
Encounter Date: 05/29/2009
Last: Gomez
First: Adelina
DOB: 04/18/1960
County: Gwinnett
Street: 1256 Indian Way # 1-F
City: Lilburn
State: GA

Zip

30047-

Cell

(770) 235-2987

Family Status

Single adult

COB

El Salvador

Gender

Female

Housing

Doubling Up

Education Level

Adult, no formal education

Home Owner

YES

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: YES
Relative: YES
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