Pancho - MUÑ-ZIT-02

Code: MUÑ-ZIT-02
Mercy ID: V-01279-11
Encounter Date: 12/10/2003
Last: Muñoz
First: Zitlaly
DOB: 08/14/2002
County: Gwinnett
Street: 3100 Sweetwater Rd. #2007
City: Lawrenceville
State: GA

Zip

30044-

Home

(770) 256-2838

Family Status

Attached youth

COB

USA

Gender

Female Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Maria R. Bazan	05/04/1975	Perú
Father	Joel Muñoz	11/11/1975	Mexico
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
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