Pancho - DOM-ELV-74

Code: DOM-ELV-74
Mercy ID: V-01415-01
Encounter Date: 11/10/2003
Last: Dominguez
First: Elvira
DOB: 01/12/1974
County: Fulton
Street: 3968 Lasaye Way
City: Atlanta
State: GA

Zip

30331-3806

Home

(404) 696-6585

Family Status

Two parent family w/children

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: 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. Perez
Data Entry: K. Aleman