PAN-AMA-01

Code
PAN-AMA-01
Mercy ID
V-00960-11
Encounter Date
06/26/2002
Last
Pantoja
First
Amalia
DOB
03/08/2001
County
Fulton
Street
5735 Roswell Rd. #635
City
Atlanta
State
GA
Zip
30342-
Home
(404) 236-0902
Family Status
Attached youth
COB
Mexico
Gender
Female Child
Housing
Doubling Up
Education Level
Child, not in school
Home Owner
YES

Parents Information

Name DOB COB
Mother Ignacia Peña Castaño 02/01/1968 Mexico
Father Cirilo Pantoja N/A Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Mother
Name of School
N/A
Grade
N/A
Who Can't Pickup the Child

Media

NO DOY PERMISO
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