Pancho - ROM-ROS-77

Code: ROM-ROS-77
Mercy ID: V-03489-01
Encounter Date: 12/22/2010
Last: Romero
First: Rosa
DOB: 11/11/1977
County: Gwinnett
Street: 1088 Blazing Ridge Road
City: Lawrenceville
State: GA

Zip

30046-

Cell

(770) 882-9494

Family Status

Single parent w/children

COB

Honduras

Gender

Female

Housing

Doubling Up

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