Pancho - MER-MIC-98

Code: MER-MIC-98
Mercy ID: V-01886-22
Encounter Date: 04/02/2008
Last: Mera
First: Nick
DOB: 06/20/1998
County: Gwinnett
Street: 4498 Buford Hwy Lot 203
City: Norcross
State: GA

Zip

30071-

Cell

(678) 755-8251

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Single Family

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Lisbeth Chonay	12/30/1972	Guatemala
Father	Elliot Mera	08/07/1969	Colombia
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Baker Lake
Grade: 3rd.
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: C. Alvarado
Data Entry: J. Manzo