Pancho - DOM-KIM-95

Code: DOM-KIM-95
Mercy ID: V-00974-11
Encounter Date: 08/20/2003
Last: Dominguez
First: Kimberly
DOB: 09/06/1995
County: Gwinnett
Street: 228 Griffin St.
City: Lawrenceville
State: GA

Zip

30045-

Home

(770) 682-3130

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Not Homeless

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Consuelo Dominguez	12/17/1975	Dominican Rep
Father	Tahir Bashir	06/30/1973	Pakistan
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Lawrenceville Elementary
Grade: 2nd.
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: Y. Garcia
Data Entry: K. Aleman