Pancho - DEL-SAL-06

Code: DEL-SAL-06
Mercy ID: V-02770-12
Encounter Date: 04/30/2008
Last: De la rosa
First: Sally
DOB: 05/29/2006
County: Gwinnett
Street: 2571 Ripple Way
City: Lawrenceville
State: GA

Zip

30043-

Home

(770) 962-5622

Cell

(678) 365-7950

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Martha Raudales	06/17/1981	Mexico
Father	Alejandro de la Rosa	05/30/1975	Mexico
Step Parent	N/A	N/A	N/A

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: C. Martinez
Data Entry: J. Manzo