Pancho - ROD-ROS-73

Code: ROD-ROS-73
Mercy ID: V-01240-01
Encounter Date: 06/04/2003
Last: Rodriguez
First: Rosa
DOB: 06/27/1973
County: Clayton
Street: 4248 Cleveland Dr.
City: Forest park
State: GA

Zip

30297-

Home

(404) 361-8851

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

Grade school

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