Pancho - GON-MIR-63

Code: GON-MIR-63
Mercy ID: V-03473-01
Encounter Date: 11/09/2010
Last: Gonzalez
First: Miriam ii
DOB: 11/21/1963
County: Gwinnett
Street: 4039 Northridge Way # -5
City: Norcross
State: GA

Zip

30093-

Cell

(678) 851-7145

Family Status

Single parent w/children

COB

Guatemala

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: 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: G. Landeros
Data Entry: J. Manzo