Pancho - MON-MAT-00

Code: MON-MAT-00
Mercy ID: V-00617-21
Encounter Date: 07/25/2001
Last: Montoya
First: Mathew
DOB: 05/26/2000
County: Dekalb
Street: 4371 Winter Chapel Rd. Apt. 514
City: Doraville
State: GA

Zip

30360-

Home

(678) 421-1941

Family Status

Attached youth

COB

Colombia

Gender

Male Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Claudia Ortiz	05/04/1966	Colombia
Father	Oscar Montoya	08/08/1965	Colombia
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: N/A
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: J. Manzo
Data Entry: K. Aleman