Pancho - BAL-JUA-92

Code: BAL-JUA-92
Mercy ID: V-00464-21
Encounter Date: 03/26/2008
Last: Baltazar
First: Juan david
DOB: 11/03/1992
County: Fulton
Street: 4825 North Bridge
City: Alpharetta
State: GA

Zip

30022-

Home

(770) 619-3272

Family Status

Child/Youth

COB

Mexico

Gender

Male Child

Housing

Single Family

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Liliana Mejia	03/14/1976	Mexico
Father	N/A	N/A	N/A
Step Parent	Wilfredo Mejia	12/09/1969	Honduras

Driver: No
Relative: No
Stranger: No
Lives With: Mother w/Stepfather
Name of School: chatahoochee H.S.
Grade: 9th.
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: C. Martinez
Data Entry: J. Manzo