Pancho - MAR-LET-67

Code: MAR-LET-67
Mercy ID: V-03461-01
Encounter Date: 11/10/2010
Last: Martinez
First: Leticia
DOB: 05/09/1967
County: Gwinnett
Street: 200 Pinevalley Cr.
City: Lawrenceville
State: GA

Zip

30046-

Cell

(678) 558-8577

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: 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: J. Perez
Data Entry: J. Manzo