Pancho - VAL-GIS-95

Code: VAL-GIS-95
Mercy ID: V-00353-11
Encounter Date: 06/22/2005
Last: Valentin
First: Gisela
DOB: 12/23/1995
County: Gwinnett
Street: 100 Castor Dr. Apt F2
City: Norcross
State: GA

Zip

30071-

Home

(770) 368-3088

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Doubling Up

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Kehila Ibarra	05/03/1981	Mexico
Father	Ramiro Valentin	06/19/1971	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: N/A
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: Y. Garcia
Data Entry: K. Aleman