Pancho - GUT-JON-01

Code: GUT-JON-01
Mercy ID: V-02332-22
Encounter Date: 09/27/2006
Last: Gutierrez
First: Jonathan
DOB: 11/02/2001
County: Cobb
Street: 1613 Bridge Mill Dr. Apt K
City: Marietta
State: GA

Zip

30067-

Home

(678) 789-1476

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Maria Gaytan	11/18/1978	Mexico
Father	N/A	N/A	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: Volunteer
Data Entry: J. Manzo