Pancho - SAN-TIF-03

Code: SAN-TIF-03
Mercy ID: V-02513-11
Encounter Date: 06/06/2007
Last: Santos
First: Tiffani
DOB: 10/21/2003
County: Dekalb
Street: 2203 Plaster Rd.
City: Atlanta
State: GA

Zip

30345-

Home

(404) 353-2629

Family Status

Child/Youth

COB

Mexico

Gender

Female Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Maria Vargas	05/12/1980	Mexico
Father	Angel Santos	10/11/1976	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
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: J. Manzo