Pancho - MAT-GEN-02

Code: MAT-GEN-02
Mercy ID: V-01392-13
Encounter Date: 10/29/2003
Last: Mata
First: Genesis
DOB: 01/11/2002
County: Dekalb
Street: 1843 A Skyland Terrace
City: Atlanta
State: GA

Zip

30319-

Home

(404) 638-6899

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Maria Villanueva	05/06/1971	Mexico
Father	Jose Mata	09/18/1977	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: K. Aleman
Data Entry: K. Aleman