Pancho - CON-CIN-84

Code: CON-CIN-84
Mercy ID: V-03055-01
Encounter Date: 04/22/2009
Last: Contreras
First: Cinthia
DOB: 04/23/1984
County: Cobb
Street: 1915 Cardell Road L-E 31
City: Austell
State: GA

Zip

30168-

Cell

(678) 949-0657

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Single Family

Education Level

Grade 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