Pancho - AND-LID-07

Code: AND-LID-07
Mercy ID: V-03018-11
Encounter Date: 03/11/2009
Last: Andrade
First: Lindsay
DOB: 10/07/2007
County: Fulton
Street: 651 North Ave.
City: Hapeville
State: GA

Zip

30354-

Cell

(678) 772-4634

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Rosaura Toribio	11/13/1982	Mexico
Father	Jose Selerino	02/02/1986	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: YES
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: YES
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: C. Martinez
Data Entry: J. Manzo