Pancho - CAI-ANA-64

Code: CAI-ANA-64
Mercy ID: V-02108-01
Encounter Date: 11/29/2005
Last: Caisedo
First: Ana
DOB: 04/16/1964
County: Gwinnett
Street: 2950 Emeral Sprink
City: Lawrenceville
State: GA

Zip

30045-

Home

(770) 913-8720

Family Status

Single parent w/children

COB

Colombia

Gender

Female

Housing

Transitional

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: G. Landeros
Data Entry: R. Gonzalez