Pancho - GON-JOR-94

Code: GON-JOR-94
Mercy ID: V-01118-21
Encounter Date: 02/12/2003
Last: Gonzalez
First: Jordie
DOB: 11/06/1994
County: Cobb
Street: 490 Windy Hill Apt. 2223
City: Smyrna
State: GA

Zip

30082-

Home

(678) 343-7516

Cell

(678) 608-9589

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Single Family

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Zaida Ramirez	10/12/1973	Guatemala
Father	Ramiro Gonzalez	08/11/1973	Nicaragua
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Campbell Middle
Grade: 8th.
Who Can't Pickup the Child
Authoritation Parent: YES
Authoritation Child: YES
DOY PERMISO: YES
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: K. Aleman
Data Entry: K. Aleman