Pancho - REY-EVA-69

Code: REY-EVA-69
Mercy ID: V-03402-01
Encounter Date: 08/24/2010
Last: Reyna
First: Evangelina
DOB: 03/10/1969
County: Gwinnett
Street: 5817 Brooklyn Lane
City: Norcross
State: GA

Zip

30093-

Cell

(770) 866-6775

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Single Family

Education Level

High school graduate

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