Pancho - BLA-MOI-99

Code: BLA-MOI-99
Mercy ID: V-00582-21
Encounter Date: 07/11/2001
Last: Blandon
First: Moises
DOB: 04/30/1988
County: Dekalb
Street: 3700 Bufod Hwy Apt. 63
City: Atlanta
State: GA

Zip

30329-

Home

(000) 000-0000

Family Status

Attached youth

COB

Nicaragua

Gender

Male Child

Housing

Not Homeless

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Silvia Umaña	N/A	Nicaragua
Father	N/A	N/A	Mexico
Step Parent	Ricardo Dominguez	N/A	Mexico

Driver: No
Relative: No
Stranger: No
Lives With: Mother w/Stepfather
Name of School: Sequoyah Middle
Grade: 8th.
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: K. Aleman