Pancho - PAR-GLA-59

Code: PAR-GLA-59
Mercy ID: V-03120-01
Encounter Date: 07/15/2009
Last: Parra
First: Gladys
DOB: 09/08/1959
County: Forsyth
Street: 999 no la quiso dar
City: Cummings
State: GA

Zip

99999-

Cell

(678) 755-5852

Family Status

Adult couple-no children

COB

Colombia

Gender

Female

Housing

Single Family

Education Level

High school graduate

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: 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: G. Landeros
Data Entry: J. Manzo