Pancho - MOL-BLA-95

Code: MOL-BLA-95
Mercy ID: V-02820-11
Encounter Date: 06/25/2008
Last: Molina
First: Blanca
DOB: 12/15/1995
County: Gwinnett
Street: 171 Pepper Mill Rd.
City: Lawrenceville
State: GA

Zip

30045-

Cell

(678) 517-4041

Family Status

Child/Youth

COB

El Salvador

Gender

Female Child

Housing

Single Family

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Blanca Medrano	04/27/1974	El Salvador
Father	Dermes Renato Molina	05/27/1964	Honduras
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Richard School
Grade: 7th.
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