Pancho - GAL-GLO-70

Code: GAL-GLO-70
Mercy ID: V-01325-01
Encounter Date: 08/14/2003
Last: Galvan
First: Gloria
DOB: 08/20/1970
County: Cobb
Street: 5881 South Gordon Rd.
City: Austell
State: GA

Zip

30168-

Home

(770) 739-8033

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

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