Pancho - MEJ-TIF-02

Code: MEJ-TIF-02
Mercy ID: V-00464-11
Encounter Date: 03/28/2008
Last: Mejia
First: Tiffany
DOB: 11/19/2002
County: Fulton
Street: 4825 Northbridge Dr.
City: Alpharetta
State: GA

Zip

30022-

Home

(770) 619-3272

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Preschool

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Liliana Mejia	03/04/1976	Mexico
Father	Wilfredo Mejia	12/09/1969	Honduras
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Primo's Road
Grade: Pre-K
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: J. Manzo