Pancho - MEN-DOR-05

Code: MEN-DOR-05
Mercy ID: V-03244-11
Encounter Date: 01/27/2010
Last: Mena
First: Dorley
DOB: 03/04/2005
County: Dekalb
Street: 1382 H North Cliff Valley Way
City: Atlanta
State: GA

Zip

30319-

Home

(404) 321-1840

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Preschool

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Diodelvina Rosado Gomez	09/15/1978	Mexico
Father	Gustavo Mena	08/29/1973	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Joshiba Head Star
Grade: N/A
Who Can't Pickup the Child
Authoritation Parent: YES
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: YES

Intake: C. Martinez
Data Entry: J. Manzo