GTI-ANY-03

Code
GTI-ANY-03
Mercy ID
V-02332-23
Encounter Date
09/27/2006
Last
Gutierrez
First
Andy
DOB
04/08/2003
County
Cobb
Street
1613 Bridge Mill Dr. Apt K
City
Marietta
State
GA
Zip
30067-
Home
(678) 789-1476
Family Status
Attached youth
COB
USA
Gender
Male Child
Housing
Not Homeless
Education Level
Child, not in school
Home Owner
No

Parents Information

Name DOB COB
Mother Maria Gaytan 11/18/1978 N/A
Father N/A N/A N/A
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Mother
Name of School
N/A
Grade
N/A
Who Can't Pickup the Child

Media

NO DOY PERMISO
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