Pancho - CIS-MEL-85

Code: CIS-MEL-85
Mercy ID: V-02696-01
Encounter Date: 01/23/2008
Last: Cisneros
First: Melina
DOB: 09/07/1985
County: Other
Street: Esta en Mexico
City: Tuxtla
State: ME

Zip

99999-

Cell

(919) 112-1122

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

some high 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: J. Perez
Data Entry: J. Manzo