Pancho - RME-TNA-71

Code: RME-TNA-71
Mercy ID: V-03309-01
Encounter Date: 04/23/2010
Last: Romero
First: Tania
DOB: 11/02/1971
County: Gwinnett
Street: 6800 Peachtree Ind. Blvd. # 1
City: Doraville
State: GA

Zip

30324-

Home

(407) 844-0631

Family Status

Two parent family w/children

COB

Honduras

Gender

Female

Housing

Single Family

Education Level

Grade school

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: 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