Pancho - MEN-EMI-04

Code: MEN-EMI-04
Mercy ID: V-02323-22
Encounter Date: 09/27/2006
Last: Mendoza
First: Emiliano
DOB: 01/24/2004
County: Cobb
Street: 6109 Black Hawk Trail
City: Mableton
State: GA

Zip

30126-

Home

(678) 698-2419

Family Status

Attached youth

COB

USA

Gender

Male Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Laura Calderon	09/19/1972	Mexico
Father	Mario Mendoza	10/22/1966	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: Volunteer
Data Entry: J. Manzo