Pancho - PIN-JES-84

Code: PIN-JES-84
Mercy ID: V-01930-01
Encounter Date: 06/09/2005
Last: Pineda
First: Jesenia
DOB: 06/04/1984
County: Henry
Street: 32 Pool C8
City: Ellenwood
State: GA

Zip

00000-

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

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: 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: G. Landeros
Data Entry: K. Aleman