GAY-ERI-03

Code
GAY-ERI-03
Mercy ID
V-02026-22
Encounter Date
04/28/2008
Last
Gaytan
First
Erick
DOB
10/23/2003
County
Dekalb
Street
3559 Pleasant Brook Village Lane
City
Doraville
State
GA
Zip
30340-
Home
(678) 534-1297
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Single Family
Education Level
Child, not in school
Home Owner
YES

Parents Information

Name DOB COB
Mother Veronica Cid 04/01/1976 Mexico
Father Jorge Gaytan 11/28/1977 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Parents
Name of School
N/A
Grade
N/A
Who Can't Pickup the Child

Media

NO DOY PERMISO
Authoritation Parent
No
Authoritation Child
No
DOY PERMISO
No
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
G. Landeros
Data Entry
J. Manzo