Pancho - DIA-EDW-02

Code: DIA-EDW-02
Mercy ID: V-02205-22
Encounter Date: 03/22/2006
Last: Diaz gutierrez
First: Edwin allan
DOB: 11/24/2002
County: Gwinnett
Street: 2606 Park Colony Dr
City: Norcross
State: GA

Zip

30093-

Home

(770) 491-0412

Family Status

Attached youth

COB

USA

Gender

Male Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Rocio Gutierrez	08/12/1979	Mexico
Father	Osvaldo Diaz	09/27/1973	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
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: Volunteer
Data Entry: R. Gonzalez