Pancho - MEN-CIT-92

Code: MEN-CIT-92
Mercy ID: V-01126-11
Encounter Date: 02/19/2003
Last: Mendoza
First: Citlaly
DOB: 11/09/1992
County: Fulton
Street: 55 Northwood Dr. Apt. 31
City: Atlanta
State: GA

Zip

30342-

Home

(404) 257-1429

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Not Homeless

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Paola Petatan	04/10/1970	Mexico
Father	Jorge Mendoza	02/22/1964	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Heards Ferry
Grade: 5th.
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. Perilla
Data Entry: K. Aleman