Pancho - ROS-REI-08

Code: ROS-REI-08
Mercy ID: V-03310-23
Encounter Date: 04/28/2010
Last: Rosales
First: Reilly
DOB: 02/28/2008
County: Dekalb
Street: 1313 Brook Ave.
City: Doraville
State: GA

Zip

30340-

Cell

(678) 600-7094

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Single Family

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Magdalena Lopez	10/03/1985	Mexico
Father	Nazario Rosales	11/11/1982	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother w/Stepfather
Name of School: N/A
Grade: N/A
Who Can't Pickup the Child
Authoritation Parent: YES
Authoritation Child: No
DOY PERMISO: YES
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: C. Martinez
Data Entry: J. Manzo