Pancho - PER-SER-98

Code: PER-SER-98
Mercy ID: V-02906-21
Encounter Date: 02/09/2009
Last: Perez
First: Sergio
DOB: 07/10/1998
County: Gwinnett
Street: 6656 E. Windsor Ln
City: Norcross
State: GA

Zip

30093-

Cell

(770) 895-9354

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Doubling Up

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Eloisa Duran	05/12/1978	Mexico
Father	Jose Guadalupe Perez	08/17/1971	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Nesbit Elem
Grade: 5th.
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: J. Manzo
Data Entry: J. Manzo