Pancho - MAR-DAH-01

Code: MAR-DAH-01
Mercy ID: V-00026-12
Encounter Date: 04/17/2002
Last: Martinez
First: Dahlia
DOB: 03/02/2001
County: Cobb
Street: 3014 Estuary Road
City: Acworth
State: GA

Zip

30101-

Cell

(205) 570-2219

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Maria A. Martinez	03/18/1972	Mexico
Father	Victor Martinez	04/24/1968	Mexico
Step Parent	Jose Luis Cienfuego	08/25/1971	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother w/Stepfather
Name of School: Acworth Elemtary
Grade: 4th.
Who Can't Pickup the Child
Authoritation Parent: YES
Authoritation Child: No
DOY PERMISO: YES
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: Y. Garcia
Data Entry: K. Aleman