Pancho - MAG-AMA-02

Code: MAG-AMA-02
Mercy ID: V-01600-11
Encounter Date: 06/30/2004
Last: Magaña
First: Amalia
DOB: 12/06/2002
County: Cobb
Street: 4939 Oak Dale Apt 9K
City: Smyrna
State: GA

Zip

30080-

Home

(678) 768-2738

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	Lisa Marie Cearfoss	05/14/1985	USA
Father	Everado Magaña	02/04/1971	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