Pancho - MED-JUA-97

Code: MED-JUA-97
Mercy ID: V-00852-21
Encounter Date: 05/01/2002
Last: Medina
First: Juan
DOB: 05/28/1997
County: Gwinnett
Street: 6761 Lismore Dr.
City: Norcross
State: GA

Zip

30093-

Home

(770) 939-3083

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Doubling Up

Education Level

Preschool

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Gabriela Silva	11/11/1968	Mexico
Father	Jose I. Medina	10/06/1967	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: La Petit
Grade: Pre-K
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