Pancho - DOM-SAN-68

Code: DOM-SAN-68
Mercy ID: V-02286-01
Encounter Date: 07/12/2006
Last: Dominguez
First: Sandra
DOB: 02/06/1968
County: Dekalb
Street: 3146 Chamblee Dunwoody Rd.
City: Chamblee
State: GA

Zip

30341-

Home

(910) 233-5826

Cell

(910) 234-9385

Family Status

Single adult

COB

Mexico

Gender

Female

Housing

Transitional

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: 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: J. Manzo