Pancho - GUE-SUS-03

Code: GUE-SUS-03
Mercy ID: V-01753-11
Encounter Date: 02/02/2005
Last: Guerrero
First: Susan
DOB: 05/29/2003
County: Other
Street: 5151 B Williams Rd.
City: Norcross
State: GA

Zip

30093-

Home

(770) 925-0577

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Maria de Jesus Gonzalez	06/09/1978	Mexico
Father	Mauricio Guerrero	07/11/1978	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