Pancho - MOL-DEI-56

Code: MOL-DEI-56
Mercy ID: V-02889-01
Encounter Date: 09/10/2008
Last: Molina
First: Deisy
DOB: 10/27/1956
County: Newton
Street: 670 Pinevalle Dirve
City: Covington
State: GA

Zip

30015-

Cell

(770) 883-3226

Family Status

Two parent family w/children

COB

El Salvador

Gender

Female

Housing

Single Family

Education Level

H.S. equivalency diploma

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: J. Manzo