Pancho - PER-ELE-60

Code: PER-ELE-60
Mercy ID: V-00289-01
Encounter Date: 09/19/2000
Last: Perez
First: Elena
DOB: 09/10/1960
County: Dekalb
Street: 3852 Mc Elroy F-2
City: Oraville
State: GA

Zip

30340-

Home

(770) 234-9798

Family Status

Two parent family w/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: D. Gomez