Pancho - BUR-GLO-49

Code: BUR-GLO-49
Mercy ID: V-00006-01
Encounter Date: 01/05/2000
Last: Burgos
First: Gloria
DOB: 10/13/1949
County: Gwinnett
Street: 2828 porter dr
City: Lawrenceville
State: GA

Zip

30044-

Home

(770) 935-8464

Family Status

Adult coupie-no children

COB

Colombia

Gender

Female

Housing

Not Homeless

Education Level

High school graduate

Home Owner

YES

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. Manzo
Data Entry: D. Gomez