Pancho - SUA-LOR-72

Code: SUA-LOR-72
Mercy ID: V-02123-01
Encounter Date: 12/12/2005
Last: Suastegui
First: Lorena
DOB: 05/14/1972
County: Gwinnett
Street: 3888 Line Oak
City: Doraville
State: GA

Zip

30340-

Home

(770) 242-1835

Family Status

Two parent family w/children

COB

Mexico

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: G. Landeros
Data Entry: R. Gonzalez