Pancho - MEJ-EVE-03

Code: MEJ-EVE-03
Mercy ID: V-03425-11
Encounter Date: 01/19/2011
Last: Mejia
First: Evelyn
DOB: 10/21/2003
County: Dekalb
Street: 6750 Peachtree Boulevard
City: Atlanta
State: GA

Zip

30360-

Cell

(404) 552-2071

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Maria mayorga	07/06/1973	Mexico
Father	Rene Mejia	11/25/1974	Holanda
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Charter Elem
Grade: 1st.
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: Volunteer
Data Entry: J. Manzo