Pancho - ORG-DAV-09

Code: ORG-DAV-09
Mercy ID: V-02275-22
Encounter Date: 11/18/2009
Last: Organista
First: David
DOB: 04/23/2009
County: Fulton
Street: 5801 King Port Dr. Apt. 131
City: Atlanta
State: GA

Zip

30342-

Home

(404) 943-0442

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	Alicia Silverio	06/16/1972	Mexico
Father	Julian Organista	01/03/1966	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: C. Martinez
Data Entry: J. Manzo