Pancho - MOL-JAK-78

Code: MOL-JAK-78
Mercy ID: V-01799-01
Encounter Date: 01/10/2005
Last: Molina
First: Jakelin
DOB: 11/01/1978
County: Gwinnett
Street: 6077 South Norcross
City: Norcross
State: GA

Zip

30093-

Home

(678) 789-4921

Family Status

Single parent w/children

COB

Honduras

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