Pancho - ARI-CON-77

Code: ARI-CON-77
Mercy ID: V-01511-01
Encounter Date: 03/03/2004
Last: Arizmendi
First: Concepcion
DOB: 04/23/1977
County: Gwinnett
Street: 31 Gwinnett Dr.
City: Lawrenceville
State: GA

Zip

30045-

Home

(678) 754-9143

Cell

(678) 376-0239

Family Status

Two parent family w/children

COB

Mexico

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