Pancho - LEI-ANA-66

Code: LEI-ANA-66
Mercy ID: V-02940-01
Encounter Date: 11/11/2008
Last: Leiva
First: Ana
DOB: 03/31/1966
County: Other
Street: 228
City: Coconot
State: NC

Zip

27511-

Cell

(919) 539-9383

Family Status

Two parent family w/children

COB

Perú

Gender

Female

Housing

Single Family

Home Owner

YES

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