Pancho - FLO-YAS-04

Code: FLO-YAS-04
Mercy ID: V-02575-12
Encounter Date: 08/15/2007
Last: Flores
First: Yasmin
DOB: 11/25/2004
County: Cobb
Street: 329 Freeport Drive
City: Lawrenceville
State: GA

Zip

30045-

Cell

(678) 760-3592

Family Status

Attached youth

COB

USA

Gender

Female Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Cynthia Hernandez	07/21/1980	Mexico
Father	Fernando Flores	04/15/1978	Mexico
Step Parent	Jose Borja	09/22/1984	Mexico

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: YES
Authoritation Child: No
DOY PERMISO: YES
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: C. Martinez
Data Entry: J. Manzo