Pancho - MEJ-IVA-99

Code: MEJ-IVA-99
Mercy ID: V-00864-21
Encounter Date: 08/28/2002
Last: Mejia
First: Ivan
DOB: 04/05/1999
County: Gwinnett
Street: 4553 Burns Rd.
City: Lilburn
State: GA

Zip

30047-

Home

(770) 923-4081

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Maria Guadalupe Carrasco	12/12/1975	Mexico
Father	Ivan Mejia	10/13/1976	Honduras
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