Pancho - CAS-VER-73

Code: CAS-VER-73
Mercy ID: V-03375-01
Encounter Date: 08/03/2010
Last: Castro
First: Veronica
DOB: 04/25/1973
County: Gwinnett
Street: 1605 Straw Valley Rd.
City: Larenceville
State: GA

Zip

30043-

Cell

(770) 906-1643

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: 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