Pancho - LEI-DOL-69

Code: LEI-DOL-69
Mercy ID: V-00434-01
Encounter Date: 02/16/2001
Last: Leiva
First: Dolores
DOB: 12/20/1969
County: Not given
Street: po box 1611
City: Cornellia
State: GA

Zip

30531-

Home

(706) 754-6769

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. Manzo
Data Entry: S. Aviña