Pancho - QUE-JEN-00

Code: QUE-JEN-00
Mercy ID: V-00436-12
Encounter Date: 07/31/2002
Last: Quezada
First: Jennifer
DOB: 05/11/2000
County: Cobb
Street: 4226 Woodwinn Court
City: Doraville
State: GA

Zip

30360-

Home

(770) 457-5616

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Irma Villa	N/A	Mexico
Father	Jose A. Quezada	N/A	Dominican Rep
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: Y. Garcia
Data Entry: K. Aleman