Pancho - MED-SEL-02

Code: MED-SEL-02
Mercy ID: V-02506-12
Encounter Date: 09/05/2007
Last: Medrano
First: Selena
DOB: 11/16/2002
County: Cobb
Street: 671 Air Road
City: Mableton
State: GA

Zip

30126-

Home

(770) 941-2837

Family Status

Attached youth

COB

USA

Gender

Female Child

Housing

Not Homeless

Education Level

Preschool

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Irma Villatoro	05/13/1974	El Salvador
Father	Santos Medrano	01/01/1962	El Salvador
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Austel Preschool
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: C. Martinez
Data Entry: Volunteer