Pancho - MAR-REB-91

Code: MAR-REB-91
Mercy ID: V-00207-11
Encounter Date: 05/02/2001
Last: Martinez
First: Rebecca
DOB: 05/15/1991
County: Gwinnett
Street: 5191 A William Rd
City: Norcross
State: GA

Zip

30093-

Home

(000) 000-0000

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Doubling Up

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Rosa Ortiz	03/01/1963	Mexico
Father	Mario Martinez	11/21/1961	Mexico
Step Parent	Jose Luis Perez	06/23/1961	Mexico

Driver: No
Relative: No
Stranger: No
Lives With: N/A
Name of School: Road Ridge Elementary
Grade: 3rd.
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: K. Aleman
Data Entry: K. Aleman