Pancho - LEP-EME-05

Code: LEP-EME-05
Mercy ID: V-01264-12
Encounter Date: 11/01/2006
Last: Lep
First: Emily
DOB: 08/25/2005
County: Gwinnett
Street: 1435 Danbury Dr.
City: Norcross
State: GA

Zip

30093-

Cell

(678) 508-2711

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Sonia Xicara	12/24/1966	Guatemala
Father	Edgar Lep	05/08/1972	Guatemala
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: N/A
Grade: N/A
Who Can't Pickup the Child: Edgar Lep -Father
Authoritation Parent: No
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: C. Martinez
Data Entry: J. Manzo