Pancho - BOS-KET-70

Code: BOS-KET-70
Mercy ID: V-01517-01
Encounter Date: 03/08/2004
Last: Bosque
First: Ketsy
DOB: 09/04/1970
County: Other
Street: some street in Puerto Rico
City: Some city
State: GA

Zip

00000-0000

Home

(787) 826-8124

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

Other

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: 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