Pancho - NAR-KAT-05

Code: NAR-KAT-05
Mercy ID: V-03494-12
Encounter Date: 01/19/2011
Last: Narciso
First: Kattie
DOB: 09/03/2005
County: Fulton
Street: 22 Peachtree Ave.
City: Atlanta
State: GA

Zip

99999-

Cell

(678) 608-7481

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Doubling Up

Education Level

Preschool

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Reyna Ramirez	01/08/1979	Mexico
Father	Mauro Narciso	03/09/1978	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Shine House
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