Pancho - MAL-DLI-02

Code: MAL-DLI-02
Mercy ID: V-02551-22
Encounter Date: 04/15/2009
Last: Maldonado
First: Lisandro
DOB: 01/20/2002
County: Cobb
Street: 540 Cobb Circle
City: Smyrna
State: GA

Zip

30082-

Cell

(770) 895-0023

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Doubling Up

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Matilde Perez	03/14/1979	Mexico
Father	Rodrigo Maldonado	03/13/1977	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Northon Park
Grade: 1st.
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: J. Manzo