Pancho - BON-MEL-04

Code: BON-MEL-04
Mercy ID: V-01291-11
Encounter Date: 07/20/2005
Last: Bonilla
First: Melanie kristin
DOB: 05/10/2004
County: Fulton
Street: 5013 Garner Dr.
City: Alpharetta
State: GA

Zip

30004-

Home

(678) 768-6567

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Karssira Morales	05/08/1984	Guatemala
Father	Oscar Bonilla	01/30/1984	Mexico
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