Pancho - PAL-BRA-98

Code: PAL-BRA-98
Mercy ID: V-00736-12
Encounter Date: 11/28/2001
Last: Palacios
First: Brandon
DOB: 02/04/1998
County: Gwinnett
Street: 6987 Magnolia Park Dr.
City: Norcross
State: GA

Zip

30093-

Home

(770) 938-2294

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Blanca Estela Ortiz	03/22/1973	Mexico
Father	Demetrio Palacios	12/22/1969	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
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: Y. Garcia
Data Entry: K. Aleman