Pancho - ROD-CAR-04

Code: ROD-CAR-04
Mercy ID: V-03277-13
Encounter Date: 03/31/2010
Last: Rodriguez
First: Carolina
DOB: 09/04/2004
County: Dekalb
Street: 1195 Reilly Lane
City: Clarkston
State: GA

Zip

30021-

Home

(404) 508-8958

Cell

(404) 569-8819

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Preschool

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Bertha Palmerin	02/17/1973	Mexico
Father	Isaias Rodriguez	06/07/1973	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Jolly Elem
Grade: Pre-K
Who Can't Pickup the Child
Authoritation Parent: YES
Authoritation Child: No
DOY PERMISO: YES
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: C. Martinez
Data Entry: J. Manzo