Pancho - MEJ-ELD-78

Code: MEJ-ELD-78
Mercy ID: V-01913-01
Encounter Date: 05/20/2005
Last: Mejia
First: Elda
DOB: 07/29/1978
County: Dekalb
Street: 3282 Scarlet Oak
City: Atlanta
State: GA

Zip

30340-

Home

(770) 409-1578

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

Other

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