Pancho - MON-LUI-02

Code: MON-LUI-02
Mercy ID: V-02403-21
Encounter Date: 01/27/2010
Last: Montes
First: Luis
DOB: 05/25/2002
County: Clayton
Street: 5086 Old Dixie Hwy # 1221
City: Forest park
State: GA

Zip

30296-

Cell

(404) 573-0483

Family Status

Child/Youth

COB

Mexico

Gender

Male Child

Housing

Doubling Up

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Erica Chavez	08/14/1988	Mexico
Father	Isaias Montes	N/A	Mexico
Step Parent	Martin Rivera	08/08/1976	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Unidos
Grade: 2nd.
Who Can't Pickup the Child
Authoritation Parent: YES
Authoritation Child: No
DOY PERMISO: YES
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: Volunteer
Data Entry: J. Manzo