Pancho - RIV-GEN-79

Code: RIV-GEN-79
Mercy ID: V-00998-01
Encounter Date: 08/14/2002
Last: Rivera
First: Genata
DOB: 01/11/1979
County: Fulton
Street: 1632 Wood Creek
City: Roswell
State: GA

Zip

30076-

Home

(770) 992-5177

Family Status

Two parent family w/children

COB

Puerto Rico

Gender

Female

Housing

Not Homeless

Education Level

College Degree

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: K. Aleman