Pancho - SUA-BLA-75

Code: SUA-BLA-75
Mercy ID: V-03443-01
Encounter Date: 10/11/2010
Last: Suarez
First: Blanca
DOB: 04/18/1975
County: Gwinnett
Street: 2576 Jimmy Carter Apt. 1-B
City: Norcross
State: GA

Zip

30092-

Cell

(404) 396-3819

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: 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