Pancho - PLA-TER-84

Code: PLA-TER-84
Mercy ID: V-03370-01
Encounter Date: 07/26/2010
Last: Plasencia
First: Teresa
DOB: 03/21/1984
County: Gwinnett
Street: 107 Dearing Court
City: Mableton
State: GA

Zip

30126-

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Single Family

Education Level

some high 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