Pancho - MAR-DIO-94

Code: MAR-DIO-94
Mercy ID: V-01095-12
Encounter Date: 01/14/1998
Last: Mariche
First: Diocelin
DOB: 03/27/1994
County: Other
Street: 201 Copeland Rd.
City: Roswell
State: GA

Zip

00000-0

Home

(000) 000-0000

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Other

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Maximina Mariche	06/07/1971	Mexico
Father	Maurino Mariche	06/10/1966	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: N/A
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: J. Manzo
Data Entry: K. Aleman