Pancho - MEN-VIO-01

Code: MEN-VIO-01
Mercy ID: V-00506-14
Encounter Date: 10/02/2002
Last: Mendez
First: Violeta
DOB: 04/25/2001
County: Dekalb
Street: 1800 Memorial Dr. Apt. J3
City: Atlanta
State: GA

Zip

00000-0000

Home

(404) 373-5197

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Maria Mendez	N/A	Mexico
Father	N/A	N/A	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
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: Y. Garcia
Data Entry: K. Aleman