Pancho - VAL-JOS-70

Code: VAL-JOS-70
Mercy ID: V-01880-01
Encounter Date: 03/11/2005
Last: Valdez
First: Josefina
DOB: 03/17/1970
County: Dekalb
Street: 280 Briarlake Ct.
City: Chamblee
State: GA

Zip

30345-

Home

(404) 982-9067

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: No
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: G. Landeros
Data Entry: K. Aleman