Pancho - DEL-EMI-95

Code: DEL-EMI-95
Mercy ID: V-01026-11
Encounter Date: 11/13/2002
Last: De la mora
First: Emily
DOB: 03/08/1995
County: Gwinnett
Street: 4083 Sugar Mill Dr.
City: Duluth
State: GA

Zip

30096-

Home

(678) 473-9148

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Doubling Up

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Genoveva Carmona	10/25/1964	Mexico
Father	Juan de Mora	02/14/1961	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Vivian Harris Elementary
Grade: 2nd.
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