Pancho - CAR-FAT-02

Code: CAR-FAT-02
Mercy ID: V-02560-11
Encounter Date: 08/08/2007
Last: Carmona
First: Fatima
DOB: 12/18/2002
County: Dekalb
Street: 999 Shelter
City: Snellvillelithonia
State: GA

Zip

30058-

Cell

(229) 869-9635

Family Status

Attached youth

COB

USA

Gender

Female Child

Housing

Shelter

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Maria Irene Balderas	06/13/1975	Mexico
Father	Josue Carmona	09/10/1966	USA
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Pre K Lithonia
Grade: Pre-K
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