Pancho - SAN-RIC-95

Code: SAN-RIC-95
Mercy ID: V-00510-21
Encounter Date: 09/25/2002
Last: Peña
First: Ricardo
DOB: 04/16/1995
County: Dekalb
Street: 3379 Aztec Rd. #5c
City: Doraville
State: GA

Zip

30340-

Home

(770) 936-0212

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Not Homeless

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Rocio Peña	10/28/1970	Mexico
Father	Ricardo Peña	11/07/1965	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Cary Reynolds
Grade: 2nd.
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: Y. Garcia