Pancho - MED-JOR-94

Code: MED-JOR-94
Mercy ID: V-01624-23
Encounter Date: 06/09/2004
Last: Medina
First: Jorge
DOB: 01/23/1994
County: Dekalb
Street: 1700 McKenzee Rd.
City: Decatur
State: GA

Zip

30032-

Home

(404) 286-2732

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Doubling Up

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Juana Nava Medina	06/24/1968	Mexico
Father	N/A	N/A	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: N/A
Grade: 5th.
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: R. Miranda