Pancho - GAM-DAI-92

Code: GAM-DAI-92
Mercy ID: V-02834-11
Encounter Date: 06/25/2008
Last: Gamboa
First: Daisy
DOB: 04/12/1992
County: Cobb
Street: 3095 Palomino Dr.
City: Pwer springs
State: GA

Zip

30127-

Home

(678) 402-5631

Cell

(678) 732-6206

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Doubling Up

Education Level

some high school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Maribel Gamboa	09/15/1970	Mexico
Father	Jorge Gamboa	03/16/1964	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Mceochern H.S.
Grade: 11th.
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