Pancho - ROM-ELI-80

Code: ROM-ELI-80
Mercy ID: V-01677-01
Encounter Date: 08/06/2004
Last: Roman
First: Elizabeth
DOB: 09/11/1980
County: Dekalb
Street: Shelter
City: Not given
State: GA

Zip

00000-0000

Home

(404) 702-0555

Family Status

Adult coupie-no children

COB

Mexico

Gender

Female

Housing

Shelter

Education Level

Some College

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