Pancho - MAN-JAN-66

Code: MAN-JAN-66
Mercy ID: V-01116-01
Encounter Date: 02/12/2003
Last: Mantilla
First: Janett
DOB: 01/02/1966
County: Dekalb
Street: 2813 Belaire Cir.
City: Doraville
State: GA

Zip

30340-

Home

(678) 547-0626

Family Status

Two parent family w/children

COB

Nicaragua

Gender

Female

Housing

Doubling Up

Education Level

Grade 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
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