Pancho - MEN-MOI-90

Code: MEN-MOI-90
Mercy ID: V-02803-21
Encounter Date: 05/28/2008
Last: Mendez
First: Moises
DOB: 01/14/1994
County: Gwinnett
Street: 956 Walnut Dr.
City: Lawrenceville
State: GA

Zip

30044-

Cell

(678) 499-3318

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	Juana Serna	05/08/1971	Mexico
Father	Felipe Mendez	03/16/1967	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Sweet Water Middle
Grade: 7th.
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