Pancho - VEL-LUI-02

Code: VEL-LUI-02
Mercy ID: V-01186-11
Encounter Date: 04/16/2003
Last: Velez
First: Luisa
DOB: 08/12/2002
County: Gwinnett
Street: 2434 Oxwell Way
City: Duluth
State: GA

Zip

30096-

Home

(678) 473-1360

Family Status

Attached youth

COB

Colombia

Gender

Female Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Doris Stella Carillo	07/19/1968	Colombia
Father	Ivan Velez	10/31/1969	Colombia
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