Pancho - PER-DAY-06

Code: PER-DAY-06
Mercy ID: V-03227-11
Encounter Date: 01/20/2010
Last: Perez
First: Dayanara
DOB: 04/14/2006
County: Dekalb
Street: 2377 Woodside way
City: Atlanta
State: GA

Zip

30341-

Home

(404) 552-1661

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Preschool

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Gwendolyne Gomez	11/24/1979	Mexico
Father	Juan Angel Perez	04/24/1979	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Kinder Care Learning Center
Grade: Kinder
Who Can't Pickup the Child
Authoritation Parent: YES
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: C. Martinez
Data Entry: J. Manzo