Pancho - RUI-ROS-76

Code: RUI-ROS-76
Mercy ID: V-01322-01
Encounter Date: 08/21/2003
Last: Ruiz
First: Rosa
DOB: 01/12/1976
County: Other
Street: 924 Peachtree Station Circle
City: Peachtree
State: GA

Zip

30269-

Home

(770) 632-9599

Family Status

Two parent family w/children

COB

El Salvador

Gender

Female

Housing

Not Homeless

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. Manzo
Data Entry: K. Aleman