Pancho - BEC-LET-74

Code: BEC-LET-74
Mercy ID: V-03454-01
Encounter Date: 10/21/2010
Last: Becerra
First: Leticia
DOB: 04/16/1974
County: Hall
Street: 3201 Rose peal St.
City: Gainsville
State: GA

Zip

30507-

Cell

(770) 531-4388

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: 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