PIA-LIC-96

Code
PIA-LIC-96
Mercy ID
V-03163-11
Encounter Date
09/23/2009
Last
Pia
First
Licy
DOB
12/03/1996
County
Dekalb
Street
17 Clairview Dr.
City
Chamblee
State
GA
Zip
30341-
Cell
(678) 592-8010
Family Status
Child/Youth
COB
Guatemala
Gender
Female Child
Housing
Doubling Up
Education Level
Grade school
Home Owner
No

Parents Information

Name DOB COB
Mother Maria Lemus 08/28/1962 Guatemala
Father Victoriano Pia 11/17/1965 Guatemala
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
Medical Alert
NOTES
Grass Alergy
Lives With
Parents
Name of School
Squoya Middle School
Grade
6th.
Who Can't Pickup the Child

Media

NO DOY PERMISO
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