Pancho - FOR-LES-02

Code: FOR-LES-02
Mercy ID: V-03017-11
Encounter Date: 04/01/2009
Last: Fortuna
First: Lesly
DOB: 08/02/2002
County: Gwinnett
Street: 9204 Downleaf Arcway
City: Norcross
State: GA

Zip

30093-

Cell

(678) 687-2619

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	N/A	N/A	N/A
Father	Felix Fortuna	10/05/1979	Dominican Rep
Step Parent	Melissa Tejada	10/01/1988	Dominican Rep

Driver: No
Relative: No
Stranger: No
Lives With: Father w/Stepmother
Name of School: Monor 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: C. Martinez
Data Entry: J. Manzo