Pancho - TIE-MIR-04

Code: TIE-MIR-04
Mercy ID: V-00591-12
Encounter Date: 01/28/2009
Last: Tierrafria
First: Miriam
DOB: 05/06/2004
County: Fulton
Street: 2520 Jonesboro Road L-A-35
City: Atlanta
State: GA

Zip

30315-

Cell

(404) 569-7559

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Preschool

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Irene Rivas	04/08/1980	Mexico
Father	Israel Tierrafria	01/19/1976	Mexico
Step Parent	N/A	N/A	N/A

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