Pancho - MEN-CAR-02

Code: MEN-CAR-02
Mercy ID: V-00957-12
Encounter Date: 09/18/2002
Last: Mendez
First: Carolina
DOB: 04/15/2002
County: Dekalb
Street: 3042 Clairborne Dr.
City: Duluth
State: GA

Zip

30096-

Home

(404) 982-1086

Family Status

Attached youth

COB

USA

Gender

Female Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Maria del Rosario Rosales	09/24/1977	Mexico
Father	Julian Mendez	12/30/1976	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