Pancho - COL-JEA-75

Code: COL-JEA-75
Mercy ID: V-00807-01
Encounter Date: 01/29/2002
Last: Colon
First: Jeannie
DOB: 01/09/1975
County: Cobb
Street: 803 Westrige Dr.
City: Acworth
State: GA

Zip

30101-

Home

(770) 529-2239

Family Status

Adult coupie-no children

COB

Guatemala

Gender

Female

Housing

Doubling Up

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: 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: J. Perez
Data Entry: K. Aleman