Pancho - VEL-ELE-67

Code: VEL-ELE-67
Mercy ID: V-01450-01
Encounter Date: 12/29/2003
Last: Velasquez
First: Elena
DOB: 02/11/1967
County: Dekalb
Street: 1368 N. Cliff Valley Way G5
City: Atlanta
State: GA

Zip

30319-

Home

(404) 633-4107

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: 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: K. Aleman