Pancho - CAR-DOR-68

Code: CAR-DOR-68
Mercy ID: V-01186-01
Encounter Date: 04/09/2003
Last: Carrillo
First: Doris
DOB: 07/19/1968
County: Gwinnett
Street: 2434 Oxwall Way
City: Duluth
State: GA

Zip

30096-

Home

(678) 473-1360

Family Status

Two parent family w/children

COB

Colombia

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. Manzo
Data Entry: K. Aleman