Pancho - ELE-CLA-58

Code: ELE-CLA-58
Mercy ID: V-02979-01
Encounter Date: 01/02/2009
Last: Elejalde
First: Claudia
DOB: 11/17/1958
County: Fulton
Street: 1505 Briarhill Lane NE
City: Atlanta
State: GA

Zip

30324-

Cell

(404) 551-0897

Family Status

Adult couple-no children

COB

Colombia

Gender

Female

Housing

Single Family

Education Level

Some College

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: 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. Perez
Data Entry: J. Manzo