Pancho - DIA-EST-06

Code: DIA-EST-06
Mercy ID: V-03532-11
Encounter Date: 03/02/2011
Last: Diaz
First: Estefania
DOB: 07/13/2006
County: Dekalb
Street: 426 Lincoln Ct. Ave.
City: Atlanta
State: GA

Zip

30329-

Cell

(781) 354-2992

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Preschool

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Yenny L. Lopez	03/10/1973	Colombia
Father	Hector A. Lopez	10/29/1973	Colombia
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Kinder Care
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: Volunteer
Data Entry: J. Manzo