Pancho - FLO-CAM-05

Code: FLO-CAM-05
Mercy ID: V-02562-11
Encounter Date: 12/10/2008
Last: Florentino
First: Camila
DOB: 11/25/2005
County: Fulton
Street: 5555 Roswell Road Apt. B-6
City: Sandy spring
State: GA

Zip

30342-

Cell

(404) 993-6145

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Norma Cobos	09/24/1971	Mexico
Father	Filogoneo Florentino	11/22/1978	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
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: C. Martinez
Data Entry: J. Manzo