Pancho - SOS-CLA-85

Code: SOS-CLA-85
Mercy ID: V-03201-01
Encounter Date: 11/02/2009
Last: Sosa
First: Claudia
DOB: 01/29/1985
County: Forsyth
Street: 225 Nancy Lane # 504
City: Cumming
State: GA

Zip

30040-

Cell

(678) 886-8769

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

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: G. Landeros
Data Entry: J. Manzo