Pancho - PER-MEL-05

Code: PER-MEL-05
Mercy ID: V-02037-13
Encounter Date: 09/28/2005
Last: Perez
First: Melissa
DOB: 05/05/2005
County: Douglass
Street: 5682 Favor Rd
City: Douglasville
State: GA

Zip

30319-

Home

(770) 949-8517

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Lidia Perez	05/11/1970	Mexico
Father	N/A	N/A	Mexico
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: F. Gomez
Data Entry: R. Gonzalez