Pancho - CLA-ADR-02

Code: CLA-ADR-02
Mercy ID: V-01964-11
Encounter Date: 10/17/2002
Last: Clark
First: Adriel
DOB: 10/17/2002
County: Gwinnett
Street: 164 Ashland Park Ct.
City: Lawrenceville
State: GA

Zip

30045-

Home

(770) 682-2928

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Cristina Clark	06/21/1967	Brazil
Father	Warren Shane Clark	04/17/1973	USA
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
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