Pancho - GAR-DER-04

Code: GAR-DER-04
Mercy ID: V-02171-21
Encounter Date: 05/24/2006
Last: Garcia guerrero
First: Derek
DOB: 05/14/2004
County: Dekalb
Street: 1395 North Cliff Valley Way Apt G
City: Atlanta
State: GA

Zip

30319-

Cell

(404) 849-8557

Family Status

Attached youth

COB

USA

Gender

Male Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Erika Guerrero Garcia	02/25/1983	Mexico
Father	Nestor Garcia Mayo	03/29/1979	Mexico
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: R. Gonzalez
Data Entry: R. Gonzalez