Pancho - VEN-URI-08

Code: VEN-URI-08
Mercy ID: V-00953-23
Encounter Date: 04/28/2010
Last: Ventura
First: Uriel
DOB: 07/17/2008
County: Hall
Street: 5565 Mulberry St. Apt A-S
City: Flowery branch
State: GA

Zip

30542-

Cell

(678) 887-2941

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Single Family

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Susana Ventura	08/10/1973	Mexico
Father	Elio Espinoza	10/15/1976	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: N/A
Grade: N/A
Who Can't Pickup the Child
Authoritation Parent: YES
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: YES
Limitado Caminar Latino: No

Intake: C. Martinez
Data Entry: J. Manzo