Pancho - VIV-ALE-00

Code: VIV-ALE-00
Mercy ID: V-00353-21
Encounter Date: 06/22/2005
Last: Viveros
First: Alexis
DOB: 02/27/2000
County: Gwinnett
Street: 100 Castor Dr. Apt F2
City: Norcross
State: GA

Zip

30071-

Home

(770) 368-3088

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Doubling Up

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Kehila Ibarra	05/03/1981	Mexico
Father	Guadalupe Viveros	12/12/1973	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: N/A
Grade: Kinder
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: Y. Garcia
Data Entry: K. Aleman