Pancho - JUA-EVE-03

Code: JUA-EVE-03
Mercy ID: V-01303-11
Encounter Date: 08/13/2003
Last: Juarez
First: Evelyn
DOB: 02/04/2003
County: Fulton
Street: 3410 North Fulton
City: Hapeville
State: GA

Zip

30354-

Home

(404) 767-2767

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Maria Juarez	10/18/1983	Mexico
Father	Hector Antonio	01/08/1982	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