BOT-JUA-01

Code
BOT-JUA-01
Mercy ID
V-00119-21
Encounter Date
10/06/2004
Last
Botello
First
Juan
DOB
04/14/2001
County
Dekalb
Street
1396 North Cilff Valley Way Apt G
City
Atlanta
State
GA
Zip
30319-
Home
(000) 000-0000
Family Status
Attached youth
COB
Mexico
Gender
Male Child
Housing
Doubling Up
Education Level
Child, not in school
Home Owner
No

Parents Information

Name DOB COB
Mother Elodia Sanchez 03/27/1979 Mexico
Father N/A N/A Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
N/A
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
Y. Garcia
Data Entry
K. Aleman