Pancho - VIZ-XOC-80

Code: VIZ-XOC-80
Mercy ID: V-02121-01
Encounter Date: 11/22/2005
Last: Vizcarra
First: Xochitl
DOB: 02/24/1980
County: Gwinnett
Street: 916 Montrose Parkway
City: Norcross
State: GA

Zip

30092-

Home

(678) 793-5943

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

High school graduate

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: G. Landeros
Data Entry: R. Gonzalez