Pancho - AFA-LID-67

Code: AFA-LID-67
Mercy ID: V-01347-01
Encounter Date: 11/30/1999
Last: Afanador
First: Lidia
DOB: 09/03/1967
County: Other
Street: 29 Chadfield Dr. Apt. 29-E
City: Stone mountain
State: GA

Zip

30083-

Home

(770) 465-7437

Family Status

Two parent family w/children

COB

Venezuela

Gender

Female

Housing

Doubling Up

Education Level

some high 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: K. Aleman