Pancho - CHA-JOS-79

Code: CHA-JOS-79
Mercy ID: V-01470-01
Encounter Date: 01/26/2004
Last: Chacon
First: Josefa
DOB: 08/11/1979
County: Fulton
Street: 3136 Martin Luther King
City: Atlanta
State: GA

Zip

30311-

Home

(404) 472-9172

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: 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