Pancho - CHA-SAM-99

Code: CHA-SAM-99
Mercy ID: V-01203-21
Encounter Date: 04/30/2003
Last: Chacon
First: Samuel anthony
DOB: 11/28/1999
County: Fulton
Street: 66 Northwood Dr.
City: Atlanta
State: GA

Zip

30342-

Home

(678) 886-9751

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Martha Chacon	04/28/1971	El Salvador
Father	Samuel Gonzalez	N/A	El Salvador
Step Parent	Angel Mendoza	09/15/1975	Mexico

Driver: No
Relative: No
Stranger: No
Lives With: Mother w/Stepfather
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