Pancho - ROD-MAR-68

Code: ROD-MAR-68
Mercy ID: V-03511-01
Encounter Date: 01/25/2011
Last: Rodriguez
First: Maria de lourdes
DOB: 02/11/1968
County: Hall
Street: 10 Merk St.
City: Gainsville
State: GA

Zip

30501-

Home

(678) 943-2510

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Single Family

Education Level

Grade 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