Pancho - ROS-DIA-95

Code: ROS-DIA-95
Mercy ID: V-01015-11
Encounter Date: 05/21/2003
Last: Rosales
First: Diana
DOB: 12/03/1995
County: Dekalb
Street: 6750 Peachtree Industrial Blvd. #101
City: Doraville
State: GA

Zip

30360-

Home

(404) 454-9588

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Not Homeless

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Irma Monje	03/17/1971	Guatemala
Father	Jose Rosales	06/27/1964	Guatemala
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Hightower Elementary
Grade: 1st.
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