Pancho - JAU-MON-04

Code: JAU-MON-04
Mercy ID: V-03069-11
Encounter Date: 06/17/2009
Last: Jaubert
First: Monique
DOB: 12/27/2004
County: Newton
Street: 35 whispering Pine Dr.
City: Covington
State: GA

Zip

30016-

Home

(678) 658-6216

Cell

(678) 629-6100

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Mariela Jaubert	09/27/1971	Costa Rica
Father	Jaime Rivas	03/31/1980	El Salvador
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