Pancho - GUT-JOR-06

Code: GUT-JOR-06
Mercy ID: V-02211-21
Encounter Date: 04/12/2006
Last: Gutierrez
First: Jorge luis
DOB: 04/04/2006
County: Dekalb
Street: 2761 Shallowford Dr
City: Chamblee
State: GA

Zip

30341-

Home

(678) 789-3870

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	Carmen Barela	07/16/1987	Mexico
Father	Erasmo Gutierrez	11/29/1977	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: R. Gonzalez
Data Entry: R. Gonzalez