Pancho - MON-ROS-74

Code: MON-ROS-74
Mercy ID: V-03541-01
Encounter Date: 03/11/2011
Last: Monterrosa
First: Rosivette
DOB: 12/10/1974
County: Gwinnett
Street: 3400 Sweetwater Road Apt. 105
City: Lawrenceville
State: GA

Zip

30044-

Family Status

Single parent w/children

COB

El Salvador

Gender

Female

Housing

Single Family

Education Level

Some College

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