Pancho - RIV-MON-03

Code: RIV-MON-03
Mercy ID: V-02553-11
Encounter Date: 07/25/2007
Last: Rivera
First: Monserrat
DOB: 02/26/2003
County: Dekalb
Street: 4072 Doral Dr.
City: Atlanta
State: GA

Zip

30360-

Cell

(678) 913-4187

Family Status

Attached youth

COB

USA

Gender

Female Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Maribel Ariza	08/10/1982	Mexico
Father	Edgar Rivera	05/14/1978	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