Pancho - JIM-JUA-83

Code: JIM-JUA-83
Mercy ID: V-01814-01
Encounter Date: 01/18/2005
Last: Jimenez
First: Juana
DOB: 03/25/1983
County: Dekalb
Street: 855 Pine Road
City: Stone mountain
State: GA

Zip

30083-

Home

(770) 469-4575

Family Status

Single adult

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

High school graduate

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