MEJ-JAC-69

Code
MEJ-JAC-69
Mercy ID
V-00566-01
Encounter Date
06/22/2001
Last
Mejia
First
Jacqueline sandra
DOB
05/16/1969
County
Not given
Street
P.O. Box 3128
City
Stanford
State
CT
Zip
06905-9991
Home
(203) 357-8590
Family Status
Single parent w/children
COB
Dominican Rep
Gender
Female
Housing
Shelter
Education Level
some high school
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
YES
Relative
No
Stranger
No
NOTES
Lives With
N/A
Name of School
N/A
Grade
N/A
Who Can't Pickup the Child

Media

NO DOY PERMISO
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