GOM-CON-67

Code
GOM-CON-67
Mercy ID
V-01247-01
Encounter Date
06/20/2003
Last
Gomez
First
Concepcion
DOB
07/31/1967
County
Gwinnett
Street
5705 Everglade Tr
City
Norcross
State
GA
Zip
30071-
Home
(770) 368-2789
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school
Home Owner
YES

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
NOTES
Lives With
N/A
Name of School
N/A
Grade
N/A
Who Can't Pickup the Child

Media

NO DOY PERMISO
Authoritation Parent
No
Authoritation Child
No
DOY PERMISO
No
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
J. Manzo
Data Entry
K. Aleman