Pancho - CER-AND-00

Code: CER-AND-00
Mercy ID: V-02871-11
Encounter Date: 10/20/2010
Last: Cervantes
First: Andrea
DOB: 04/23/2000
County: Dekalb
Street: 2551 Pilgrim Way Apt. A
City: Atlanta
State: GA

Zip

30345-

Cell

(678) 830-5570

Family Status

Child/Youth

COB

Guatemala

Gender

Female Child

Housing

Single Family

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Lidia Perez	08/03/1982	Guatemala
Father	N/A	N/A	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother w/Stepfather
Name of School: Dresden Elem
Grade: 5th.
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