Pancho - GUT-REY-77

Code: GUT-REY-77
Mercy ID: V-03128-01
Encounter Date: 07/02/2009
Last: Gutierrez
First: Reyna
DOB: 11/03/1977
County: Clayton
Street: 4233 Jonesboro Road B-9
City: Forest park
State: GA

Zip

30297-

Cell

(404) 363-9168

Family Status

Two parent family 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