Pancho - DIA-ELI-72

Code: DIA-ELI-72
Mercy ID: V-01637-01
Encounter Date: 05/25/2004
Last: Diaz
First: Elida
DOB: 10/22/1972
County: Clayton
Street: 6347 Tara Bulevard
City: Jonesboro
State: GA

Zip

30236-

Home

(678) 479-6594

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

some high 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