Pancho - CAM-LAU-76

Code: CAM-LAU-76
Mercy ID: V-03373-01
Encounter Date: 08/09/2010
Last: Camacho
First: Laura
DOB: 11/26/1976
County: Gwinnett
Street: 4435 Emory Rd.
City: Buford
State: GA

Zip

30518-

Cell

(770) 873-4174

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Single Family

Education Level

Some College

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