Pancho - DIA-YUR-84

Code: DIA-YUR-84
Mercy ID: V-02964-01
Encounter Date: 12/10/2008
Last: Diaz
First: Yuridia
DOB: 09/21/1984
County: Gwinnett
Street: 4885 Indian Trail Rd.
City: Lilburn
State: GA

Zip

30047-

Cell

(770) 923-9526

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Single Family

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: J. Perez
Data Entry: J. Manzo