Pancho - ORT-LUI-07

Code: ORT-LUI-07
Mercy ID: V-02623-21
Encounter Date: 10/31/2007
Last: Ortiz
First: Luis
DOB: 04/26/2007
County: Dekalb
Street: 6800 Peachtree Ind C-10
City: Doraville
State: GA

Zip

30360-

Cell

(678) 851-3568

Family Status

Attached youth

COB

USA

Gender

Male Child

Housing

Doubling Up

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Isabel Montes	12/09/1974	Mexico
Father	Jose Luis Ortiz	02/01/1978	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
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: G. Landeros
Data Entry: J. Manzo