Pancho - TEJ-MEL-88

Code: TEJ-MEL-88
Mercy ID: V-03017-01
Encounter Date: 02/25/2009
Last: Tejada
First: Melissa
DOB: 10/01/1988
County: Gwinnett
Street: 9204 Dunleaf Arc Way
City: Norcross
State: GA

Zip

30093-

Cell

(678) 687-2619

Family Status

Adult couple-no children

COB

Dominican Rep

Gender

Female

Housing

Single Family

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: G. Landeros
Data Entry: J. Manzo