Pancho - VAS-IVO-07

Code: VAS-IVO-07
Mercy ID: V-03161-11
Encounter Date: 09/16/2009
Last: Vasquez
First: Ivonne
DOB: 02/09/2007
County: Dekalb
Street: 3506 Buford Hwy
City: Atlanta
State: GA

Zip

30329-

Cell

(404) 246-4333

Family Status

Child/Youth

COB

Mexico

Gender

Female Child

Housing

Single Family

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Amparo Gomez	10/09/1958	Mexico
Father	Cresencio Vasquez	05/05/1977	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: J. Perez
Data Entry: J. Manzo