Pancho - VEG-JAZ-05

Code: VEG-JAZ-05
Mercy ID: V-02322-13
Encounter Date: 08/30/2006
Last: Vega
First: Jazmin
DOB: 07/17/2005
County: Clayton
Street: 4848 Parker St.
City: Forest park
State: GA

Zip

30297-

Family Status

Attached youth

COB

USA

Gender

Female Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Maria del Rocio Martinez	06/02/1975	Mexico
Father	Diego Vega	11/13/1958	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
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: J. Manzo