Pancho - SAM-RIT-75

Code: SAM-RIT-75
Mercy ID: V-01744-01
Encounter Date: 11/05/2004
Last: Samano
First: Rita
DOB: 06/09/1975
County: Fulton
Street: 7000 Roswell Rd Apt 354
City: Roswell
State: GA

Zip

30328-

Home

(770) 698-9633

Cell

(404) 483-7451

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