Pancho - BEN-LIL-80

Code: BEN-LIL-80
Mercy ID: V-03533-01
Encounter Date: 03/03/2011
Last: Benitez
First: Liliana
DOB: 12/09/1980
County: Dekalb
Street: 1028 Brook View Ave.
City: Doraville
State: GA

Zip

30340-

Cell

(770) 374-6996

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Single Family

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: J. Manzo