Pancho - CIS-JOS-97

Code: CIS-JOS-97
Mercy ID: V-00463-22
Encounter Date: 04/04/2001
Last: Cisneros
First: Jose
DOB: 10/23/1997
County: Dekalb
Street: 4430 tilly mill rd apt 10d
City: Doraville
State: GA

Zip

30360-

Home

(678) 530-0634

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Doubling Up

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	edith acocal	01/14/1973	Mexico
Father	eliseo cisneros	N/A	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
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: K. Aleman
Data Entry: S. Aviña