Pancho - GUT-LUI-01

Code: GUT-LUI-01
Mercy ID: V-01668-21
Encounter Date: 08/11/2004
Last: Gutierrez
First: Luis a
DOB: 06/29/2001
County: Dekalb
Street: 2515 Northeast Express Hwy Apt A 16
City: Atlanta
State: GA

Zip

30345-

Home

(404) 248-9894

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	Nadia Loera	12/17/1982	Mexico
Father	Luis Gutierrez	05/01/1979	Mexico
Step Parent	Sergio Remijio	N/A	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: R. Miranda