Pancho - GER-JOH-01

Code: GER-JOH-01
Mercy ID: V-01278-21
Encounter Date: 09/29/2004
Last: Gerardo
First: Johan
DOB: 05/07/2001
County: Fulton
Street: 1155 La Vista Rd. Apt 317
City: Atlanta
State: GA

Zip

30324-

Home

(404) 320-7916

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Not Homeless

Education Level

Preschool

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Zamilpa Ramirez	N/A	Mexico
Father	Efrain Gerardo	N/A	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: N/A
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