Pancho - JIM-MAY-82

Code: JIM-MAY-82
Mercy ID: V-01905-01
Encounter Date: 05/04/2005
Last: Jimenez
First: Mayra
DOB: 02/07/1982
County: Dekalb
Street: 4618 Peachtree #C
City: Doraville
State: GA

Zip

30640-

Cell

(770) 447-9139

Family Status

Single parent w/children

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: 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