Pancho - ANG-ANA-70

Code: ANG-ANA-70
Mercy ID: V-02158-01
Encounter Date: 02/06/2006
Last: Angulo
First: Ana yency
DOB: 10/03/1970
County: Gwinnett
Street: 2905 Centential Parkway
City: Lawrenceville
State: GA

Zip

30043-

Home

(770) 904-0664

Cell

(678) 913-5687

Family Status

Two parent family w/children

COB

Costa Rica

Gender

Female

Housing

Not Homeless

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: YES
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. Perez
Data Entry: R. Gonzalez