Pancho - MIL-ROS-75

Code: MIL-ROS-75
Mercy ID: V-00259-01
Encounter Date: 08/08/2000
Last: Miller
First: Rosario
DOB: 12/03/1975
County: Dekalb
Street: 4065 Sider Ridge Trail
City: Stone mountain
State: GA

Zip

30083-

Home

(678) 232-2095

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

some high school

Home Owner

YES

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: J. Perez
Data Entry: D. Gomez