Pancho - JIM-CRI-75

Code: JIM-CRI-75
Mercy ID: V-01472-01
Encounter Date: 01/27/2004
Last: Jimenez
First: Cristina
DOB: 07/18/1975
County: Cobb
Street: 000 some street
City: Marietta
State: GA

Zip

00000-0000

Home

(678) 354-8681

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