Pancho - CAM-ARL-99

Code: CAM-ARL-99
Mercy ID: V-02111-11
Encounter Date: 01/26/2009
Last: Camacho
First: Arlenne
DOB: 01/05/1999
County: Gwinnett
Street: 4300 Jimmy Carter Blv. # 720
City: Norcross
State: GA

Zip

30093-

Home

(770) 491-3074

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Doubling Up

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Margarita Camacho	02/22/1975	Mexico
Father	Jose Angel Rivera	02/26/1974	El Salvador
Step Parent	Carlos Amaya	10/20/1981	Mexico

Driver: No
Relative: No
Stranger: No
Lives With: Mother w/Stepfather
Name of School: Nesbit Elem.
Grade: 4th.
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: J. Manzo
Data Entry: J. Manzo