Pancho - GUT-JIM-06

Code: GUT-JIM-06
Mercy ID: V-02477-11
Encounter Date: 04/29/2008
Last: Gutierrez
First: Jimena
DOB: 07/18/2006
County: Gwinnett
Street: 2203 Plaster Rd. Apt. I-2
City: Atlanta
State: GA

Zip

30345-

Cell

(678) 389-0321

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Karla Contreras	02/05/1982	Mexico
Father	Juan Luis Gutierrez	03/22/1981	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