Pancho - RIV-DEI-71

Code: RIV-DEI-71
Mercy ID: V-03344-01
Encounter Date: 06/16/2010
Last: Rivas
First: Deisy
DOB: 03/01/1971
County: Cobb
Street: 3731 Mecedonia Rd.
City: Marietta
State: GA

Zip

30127-

Cell

(404) 713-3798

Family Status

Two parent family w/children

COB

El Salvador

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