Pancho - JIM-ANT-72

Code: JIM-ANT-72
Mercy ID: V-00889-01
Encounter Date: 04/08/2002
Last: Jimenez ramos
First: Antonia
DOB: 12/28/1972
County: Other
Street: 152 Sawgrass Manor
City: Newman
State: GA

Zip

30265-

Home

(770) 251-9416

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Transitional

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: YES
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