Pancho - SAN-YAS-03

Code: SAN-YAS-03
Mercy ID: V-03510-13
Encounter Date: 02/23/2011
Last: Santana
First: Yasimi
DOB: 01/13/2003
County: Fulton
Street: 2400 Riverwood Ln. Apt. G
City: Roswell
State: GA

Zip

30075-

Cell

(404) 447-8167

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	Martha Nuñez	02/09/1981	Mexico
Father	Uvaldo Santana	05/16/1977	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Mimosa Elem.
Grade: 2nd.
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: Volunteer
Data Entry: J. Manzo