Pancho - GOM-CEC-73

Code: GOM-CEC-73
Mercy ID: V-02974-01
Encounter Date: 12/22/2008
Last: Gomez
First: Cecilia
DOB: 11/22/1973
County: Gwinnett
Street: 2854 Regent walk Drive
City: Duluth
State: GA

Zip

30096-

Home

(678) 475-1314

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Single Family

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: J. Manzo