Pancho - KAN-MOJ-02

Code: KAN-MOJ-02
Mercy ID: V-01479-21
Encounter Date: 02/04/2004
Last: Kanth
First: Mojan
DOB: 11/28/2002
County: Dekalb
Street: 2615 Oak Shadow Lane #2627B
City: Chamblee
State: GA

Zip

30345-

Home

(404) 513-4268

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Laura Montoya	09/01/1983	Mexico
Father	Ramesh Kanth	11/27/1977	Other
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