Pancho - GAL-ESM-84

Code: GAL-ESM-84
Mercy ID: V-01931-01
Encounter Date: 06/13/2005
Last: Gallegos
First: Esmeralda
DOB: 05/28/1984
County: Dekalb
Street: 1419 North Cilff Valley #C
City: Atlanta
State: GA

Zip

30319-

Home

(404) 633-3742

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

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: G. Landeros
Data Entry: K. Aleman