Pancho - GAL-JEN-98

Code: GAL-JEN-98
Mercy ID: V-03392-11
Encounter Date: 08/25/2010
Last: Galarza
First: Jennifer
DOB: 12/02/1998
County: Cobb
Street: 2345 Cobb Parkway
City: Smyrna
State: GA

Zip

30080-

Cell

(404) 438-3721

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Aida Bautista	01/23/1980	Mexico
Father	Jose Galarza	04/12/1975	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Brandy Elem
Grade: 5th.
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