Pancho - JIM-LAU-74

Code: JIM-LAU-74
Mercy ID: V-00221-01
Encounter Date: 05/22/2000
Last: Jimenez
First: Laura
DOB: 05/14/1974
County: Gwinnett
Street: 308 Summer Place
City: Norcross
State: GA

Zip

30071-

Home

(770) 441-0953

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

Grade 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: D. Gomez