Pancho - JUA-MAI-01

Code: JUA-MAI-01
Mercy ID: V-02666-14
Encounter Date: 12/12/2007
Last: Juarez
First: Maribel
DOB: 11/23/2001
County: Clayton
Street: 812 Dougwood Trail
City: Jonesboro
State: GA

Zip

30238-

Cell

(404) 372-3489

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Graciela Juarez	04/24/1974	Mexico
Father	Lazaro Mendoza	02/22/1975	Guatemala
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Hawthorne Elem.
Grade: Kinder
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