Pancho - LAR-LUR-99

Code: LAR-LUR-99
Mercy ID: V-00740-14
Encounter Date: 11/07/2001
Last: Lara
First: Lury
DOB: 09/29/1999
County: Cherokee
Street: 640 Lake Side Dr. #2
City: Canton
State: GA

Zip

30115-

Home

(404) 401-1180

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Maria Marquez Lara	06/10/1975	Mexico
Father	Marcelino Lara	10/05/1977	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
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