Pancho - CAR-JHO-03

Code: CAR-JHO-03
Mercy ID: V-02930-21
Encounter Date: 10/22/2008
Last: Carrillo
First: Jhogan
DOB: 09/20/2003
County: Fulton
Street: 1172 Goodland Ave.
City: Atlanta
State: GA

Zip

30324-

Cell

(404) 786-4512

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Doubling Up

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Aurelia Carrillo	01/20/1984	Mexico
Father	Manuel Hernandez	01/18/1980	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Easter Seals
Grade: Pre-K
Who Can't Pickup the Child
Authoritation Parent: YES
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: YES
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: F. Gomez
Data Entry: J. Manzo