Pancho - PER-ALI-01

Code: PER-ALI-01
Mercy ID: V-01344-11
Encounter Date: 09/10/2003
Last: Perez
First: Alicia
DOB: 08/03/2001
County: Dekalb
Street: 3207 Henderson Mill Rd. G2
City: Chamblee
State: GA

Zip

30341-

Home

(770) 414-9241

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 I. Velasquez	09/04/1980	Mexico
Father	Cirio Perez	12/24/1977	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