Pancho - CAB-AZH-05

Code: CAB-AZH-05
Mercy ID: V-02964-12
Encounter Date: 12/10/2008
Last: Cabello
First: Ashly
DOB: 01/23/2005
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

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Yuridia Diaz	09/21/1984	Mexico
Father	Hendryx Colon	06/05/1964	USA
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
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