Pancho - ROL-NAT-03

Code: ROL-NAT-03
Mercy ID: V-02519-12
Encounter Date: 06/20/2007
Last: Roldan
First: Natalia
DOB: 01/17/2003
County: Gwinnett
Street: 1415 Gabriel Dr.
City: Larenceville
State: GA

Zip

30043-

Home

(770) 338-2119

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	Raquel Roldan	12/17/1961	Mexico
Father	Ramon Roldan	12/21/1957	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: C. Martinez
Data Entry: J. Manzo