PEÑ-LUI-04

Code
PEÑ-LUI-04
Mercy ID
V-02617-21
Encounter Date
10/10/2007
Last
Peñaloza
First
Luis
DOB
02/16/2004
County
Cobb
Street
584 Conneticut Rd.
City
Marietta
State
GA
Zip
99999-
Cell
(678) 768-4720
Family Status
Attached youth
COB
USA
Gender
Male Child
Housing
Not Homeless
Education Level
Child, not in school
Home Owner
YES

Parents Information

Name DOB COB
Mother Areli Cortes 03/23/1980 Mexico
Father Luis Peñaloza 11/09/1977 Mexico
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
C. Martinez
Data Entry
J. Manzo