Pancho - FON-ASH-98

Code: FON-ASH-98
Mercy ID: V-00693-11
Encounter Date: 11/28/2001
Last: Fontaine
First: Ashely
DOB: 05/28/1998
County: Cobb
Street: 7740 Poppy Dr.
City: Winston
State: GA

Zip

30197-

Home

(770) 942-8285

Cell

(678) 525-0942

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Ivonne Fontaine	02/27/1973	Mexico
Father	Marco Fontaine	09/18/1972	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: N/A
Grade: N/A
Who Can't Pickup the Child
Authoritation Parent: No
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: Y. Garcia
Data Entry: K. Aleman