Pancho - CHA-ALI-64

Code: CHA-ALI-64
Mercy ID: V-00293-01
Encounter Date: 09/25/2000
Last: Chavez
First: Elia
DOB: 04/17/1964
County: Fulton
Street: 5123 marlene dr
City: Roswell
State: GA

Zip

30075-

Home

(770) 642-5479

Family Status

Two parent family 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: YES
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: S. Aviña