Pancho - MED-LES-96

Code: MED-LES-96
Mercy ID: V-02883-11
Encounter Date: 09/03/2008
Last: Medrano
First: Leslie
DOB: 09/12/1996
County: Gwinnett
Street: 2802 Wayneheaven Oaks Way
City: Lawrenceville
State: GA

Zip

30043-

Home

(770) 904-4970

Family Status

Two parent family w/children

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Luz Maria Martinez	03/09/1957	Mexico
Father	Hermes Medrano	08/17/1969	El Salvador
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Creek Lane Midlle
Grade: 6th.
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: F. Gomez
Data Entry: J. Manzo