Pancho - TOR-UBI-63

Code: TOR-UBI-63
Mercy ID: V-00804-01
Encounter Date: 01/21/2002
Last: Torres
First: Ubielly
DOB: 01/22/1963
County: Gwinnett
Street: 1217 Stone View Tr. NW
City: Lilburn
State: GA

Zip

30047-

Home

(678) 984-1307

Family Status

Single parent w/children

COB

Colombia

Gender

Female

Housing

Not Homeless

Education Level

Grade 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: 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. Manzo
Data Entry: K. Aleman