Pancho - MID-AUR-79

Code: MID-AUR-79
Mercy ID: V-03106-01
Encounter Date: 06/25/2009
Last: Midence
First: Aurelia
DOB: 07/20/1979
County: Gwinnett
Street: 1105 Meadowood
City: Norcross
State: GA

Zip

30071-

Cell

(678) 509-4363

Family Status

Two parent family w/children

COB

Honduras

Gender

Female

Housing

Single Family

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: 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