Pancho - DAV-FAN-64

Code: DAV-FAN-64
Mercy ID: V-03103-01
Encounter Date: 06/29/2009
Last: Davis
First: Fanny
DOB: 10/07/1964
County: Gwinnett
Street: 4300 Jimmy Carter Blv.
City: Norcross
State: GA

Zip

30093-

Cell

(404) 453-1522

Family Status

Adult couple-no children

COB

Colombia

Gender

Female

Housing

Doubling Up

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: YES
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