Pancho - PER-ISA-06

Code: PER-ISA-06
Mercy ID: V-02579-21
Encounter Date: 09/05/2007
Last: Perez
First: Isac
DOB: 08/09/2006
County: Dekalb
Street: 110 High Court Place Apt. 8
City: Decatur
State: GA

Zip

30032-

Cell

(678) 531-5603

Family Status

Two parent family w/children

COB

USA

Gender

Male Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Cecilia de paz	02/24/1982	Mexico
Father	Luis Perez	07/26/1980	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