Pancho - MAR-ANA-05

Code: MAR-ANA-05
Mercy ID: V-03342-12
Encounter Date: 06/16/2010
Last: Martinez
First: Ana karen
DOB: 01/26/2005
County: Gwinnett
Street: 4515 Brandon Dr. SW
City: Lilburn
State: GA

Zip

30047-

Home

(770) 985-2583

Cell

(404) 867-0293

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Preschool

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Reyna Perez	05/24/1976	Mexico
Father	Cesar Martinez	08/04/1973	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Shilo Elem
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