Pancho - ROD-CAR-63

Code: ROD-CAR-63
Mercy ID: V-01812-01
Encounter Date: 01/24/2005
Last: Rodriguez
First: Carmen
DOB: 10/13/1963
County: Gwinnett
Street: 7214 Woodiron Dr.
City: Duluth
State: GA

Zip

30097-

Home

(770) 814-4105

Family Status

Two parent family w/children

COB

Puerto Rico

Gender

Female

Housing

Not Homeless

Education Level

Other

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