Pancho - ESP-NIC-05

Code: ESP-NIC-05
Mercy ID: V-01916-13
Encounter Date: 01/25/2006
Last: Espinal
First: Nicole
DOB: 09/07/2005
County: Dekalb
Street: 3061 Oakleaf
City: Doraville
State: GA

Zip

30340-

Home

(404) 957-2642

Family Status

Attached youth

COB

USA

Gender

Female Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Mildred Hernandez	N/A	Mexico
Father	Maximino Espinal	05/29/1980	El Salvador
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: Volunteer
Data Entry: R. Gonzalez