Pancho - CRU-DAN-09

Code: CRU-DAN-09
Mercy ID: V-02639-23
Encounter Date: 08/18/2010
Last: Cruz
First: Daniel
DOB: 01/06/2009
County: Gwinnett
Street: 1682 Pounds Rd.
City: Stone mountain
State: GA

Zip

30087-

Home

(770) 696-2283

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Karla Salinas	10/18/1988	Mexico
Father	Pedro Cruz	10/03/1982	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: YES
Authoritation Child: No
DOY PERMISO: YES
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: C. Martinez
Data Entry: J. Manzo