Pancho - JUA-BRI-00

Code: JUA-BRI-00
Mercy ID: V-02666-21
Encounter Date: 12/12/2007
Last: Juarez
First: Brian
DOB: 03/20/2000
County: Clayton
Street: 812 Dougwood
City: Jonesboro
State: GA

Zip

30238-

Cell

(404) 372-3489

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Single Family

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Graciela Juarez	04/24/1974	Mexico
Father	Alfonso Wenses	01/23/1971	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Hawthorne Elem
Grade: 2nd.
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