Pancho - MEN-IRL-07

Code: MEN-IRL-07
Mercy ID: V-03244-12
Encounter Date: 01/27/2010
Last: Mena
First: Irlanda
DOB: 06/11/2007
County: Dekalb
Street: 1382 N. 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

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Diodelina Rosado	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: N/A
Name of School: N/A
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: Volunteer
Data Entry: J. Manzo