Pancho - SER-YOL-06

Code: SER-YOL-06
Mercy ID: V-02691-13
Encounter Date: 08/06/2009
Last: Servin
First: Yoleski
DOB: 01/18/2006
County: Gwinnett
Street: 2605 Avalon Circle
City: Lawrenceville
State: GA

Zip

30044-

Cell

(678) 612-2868

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Other

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Erick Del Rosario	N/A	Dominican Rep
Father	Rogelio Servin	03/02/1982	Mexico
Step Parent	Rosa Peña	03/05/1977	Dominican Rep

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

Intake: G. Landeros
Data Entry: J. Manzo