Pancho - DOM-FEL-74

Code: DOM-FEL-74
Mercy ID: V-01765-01
Encounter Date: 11/24/2004
Last: Dominguez olivares
First: Felicitas
DOB: 07/10/1974
County: Dekalb
Street: 4430 Tilly Mill Rd.
City: Doraville
State: GA

Zip

30360-

Home

(770) 936-8916

Family Status

Adult coupie-no 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