Pancho - CAB-BRI-03

Code: CAB-BRI-03
Mercy ID: V-02964-11
Encounter Date: 12/10/2008
Last: Cabello
First: Brittania
DOB: 05/21/2003
County: Gwinnett
Street: 4885 Indian Crest Ct.
City: Lilburn
State: GA

Zip

30047-

Home

(770) 923-9526

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Preschool

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Yuridia Diaz	09/21/1984	Mexico
Father	Jose Cabello	10/09/1978	USA
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Father
Name of School: N/A
Grade: Kinder
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