Pancho - CHI-CHA-99

Code: CHI-CHA-99
Mercy ID: V-01882-22
Encounter Date: 04/20/2005
Last: Chiche
First: Charly
DOB: 09/27/1999
County: Dekalb
Street: 2287 Plaster Rd. Apt 7
City: Atlanta
State: GA

Zip

30345-

Home

(404) 399-7238

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Victoria Bello	08/21/1973	Mexico
Father	Freddy Chiche	11/09/1972	Guatemala
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: K. Aleman
Data Entry: K. Aleman