Pancho - AYA-CYN-92

Code: AYA-CYN-92
Mercy ID: V-02727-11
Encounter Date: 03/12/2008
Last: Ayala
First: Cynthia
DOB: 08/25/1992
County: Dekalb
Street: 4164 English Oak Dr.
City: Atlanta
State: GA

Zip

30340-

Home

(770) 409-2470

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Doubling Up

Education Level

some high school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Eribertha Roman	03/17/1959	Mexico
Father	Moises Ayala	09/04/1969	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Cross Keys H.S.
Grade: 9th.
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