Pancho - WHI-DZE-00

Code: WHI-DZE-00
Mercy ID: V-01491-11
Encounter Date: 05/05/2004
Last: White
First: Dze
DOB: 09/14/2000
County: Fulton
Street: 1914 Greenhouse Dr.
City: Roswell
State: GA

Zip

30076-

Home

(678) 760-2700

Family Status

Attached youth

COB

Colombia

Gender

Female Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Monica Villareal	05/04/1965	Colombia
Father	Carl White	04/12/1954	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