Pancho - MON-GEN-95

Code: MON-GEN-95
Mercy ID: V-01652-11
Encounter Date: 07/07/2004
Last: Modiagon
First: Genesis
DOB: 07/20/1995
County: Dekalb
Street: p.O. Box 1327
City: Decatur
State: GA

Zip

30031-

Home

(404) 297-5752

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Shelter

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Amalia Valencia	07/09/1975	Mexico
Father	Angel Mondragon	N/A	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: N/A
Name of School: N/A
Grade: 3rd.
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: R. Miranda