Pancho - CHA-DIA-04

Code: CHA-DIA-04
Mercy ID: V-01623-11
Encounter Date: 06/09/2004
Last: Chacon
First: Diana j
DOB: 04/20/2004
County: Gwinnett
Street: 3275 New Castle Way
City: Snellville
State: GA

Zip

30039-

Home

(678) 910-9453

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	Vilma chacon	N/A	El Salvador
Father	Arturo Chacon	07/26/1978	El Salvador
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: R. Miranda