Pancho - CHA-LET-80

Code: CHA-LET-80
Mercy ID: V-01459-01
Encounter Date: 01/05/2004
Last: Chavez
First: Leticia
DOB: 01/18/1980
County: Dekalb
Street: 4713 Bufford Hwy Apt D
City: Chamblee
State: GA

Zip

30341-

Home

(770) 451-0117

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

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: 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