Pancho - VAZ-LOR-78

Code: VAZ-LOR-78
Mercy ID: V-02080-01
Encounter Date: 10/07/2005
Last: Vazquez
First: Loreza cux
DOB: 06/03/1978
County: Dekalb
Street: 3419 Cumberland Ct #6
City: Chamblee
State: GA

Zip

30341-

Home

(404) 935-2754

Family Status

Two parent family w/children

COB

Guatemala

Gender

Female

Housing

Not Homeless

Education Level

Preschool

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: YES
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: R. Gonzalez