Pancho - GOM-JUA-73

Code: GOM-JUA-73
Mercy ID: V-00907-01
Encounter Date: 04/24/2002
Last: Gomez
First: Juana
DOB: 12/28/1973
County: Other
Street: 3876 Northside Dr. #1806
City: Macon
State: GA

Zip

31210-

Home

(478) 476-9574

Family Status

Single adult

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: J. Manzo
Data Entry: K. Aleman