Pancho - PER-RAC-01

Code: PER-RAC-01
Mercy ID: V-02801-11
Encounter Date: 06/04/2008
Last: Perez
First: Rachel
DOB: 10/31/2001
County: Fulton
Street: 1505 Chattahoochee Ave. Lot #41
City: Atlanta
State: GA

Zip

30318-

Home

(404) 604-3000

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Olga Perez	03/22/1979	Dominican Rep
Father	Mario Crusillo	01/20/1969	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: River Elem
Grade: 1st.
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: J. Manzo