Pancho - MAL-ADI-99

Code: MAL-ADI-99
Mercy ID: V-00977-13
Encounter Date: 07/17/2002
Last: Maldonado
First: Adileni
DOB: 10/12/1999
County: Fulton
Street: 4689 Roswell Rd. Apt. F3
City: Atlanta
State: GA

Zip

30342-

Home

(404) 843-0557

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	Margarita Maldonado	06/10/1972	Mexico
Father	Ismael Montufar	11/22/1972	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