Pancho - DOM-KAT-02

Code: DOM-KAT-02
Mercy ID: V-00974-13
Encounter Date: 08/20/2003
Last: Dominguez
First: Kaitlyn
DOB: 08/21/2002
County: Gwinnett
Street: 228 Griffin Street
City: Lawrenceville
State: GA

Zip

30045-

Home

(770) 682-3130

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	Consuelo Dominguez	12/17/1975	Dominican Rep
Father	Tahir Bashir	06/30/1970	Pakistan
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
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