Pancho - FAR-JAS-02

Code: FAR-JAS-02
Mercy ID: V-01846-21
Encounter Date: 04/27/2005
Last: Farias
First: Jason
DOB: 01/30/2002
County: Gwinnett
Street: 5336A Lambert Dr.
City: Norcross
State: GA

Zip

30093-

Home

(770) 925-8268

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Miosotis Farias	N/A	Other
Father	Vladimir Cuevas	01/09/1981	Dominican Rep
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: Volunteer
Data Entry: K. Aleman