Pancho - CIP-JUA-82

Code: CIP-JUA-82
Mercy ID: V-01287-01
Encounter Date: 07/14/2003
Last: Ciprian
First: Juana
DOB: 09/05/1982
County: Fulton
Street: 000 not given
City: Any city
State: GA

Zip

00000-0000

Home

(404) 610-8360

Family Status

Single adult

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: J. Perez
Data Entry: K. Aleman