Pancho - NIE-BER-70

Code: NIE-BER-70
Mercy ID: V-03121-01
Encounter Date: 07/18/2009
Last: Nieves
First: Bertha
DOB: 04/18/1970
County: Gwinnett
Street: 5932 Sugarlow # A-2
City: Norcross
State: GA

Zip

30009-

Cell

(770) 285-3856

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

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

Intake: G. Landeros
Data Entry: J. Manzo