Pancho - MED-CAR-04

Code: MED-CAR-04
Mercy ID: V-02767-21
Encounter Date: 11/12/2008
Last: Medrano
First: Carlos
DOB: 05/27/2004
County: Dekalb
Street: 3556 Old Chamblee Tucker Rd.
City: Doraville
State: GA

Zip

30340-

Cell

(404) 453-1685

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Doubling Up

Education Level

Preschool

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Elva Nato	09/03/1972	Perú
Father	Carlos Medrano	11/11/1981	El Salvador
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Jashiba Head Start
Grade: Pre-K
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