Pancho - ROM-LOU-70

Code: ROM-LOU-70
Mercy ID: V-01327-01
Encounter Date: 08/23/2003
Last: Romani
First: Lourdes
DOB: 04/14/1970
County: Gwinnett
Street: 316 Kirby Cove
City: Sugar hill
State: GA

Zip

30518-

Home

(678) 482-8980

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

High school graduate

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