Pancho - AND-JAM-07

Code: AND-JAM-07
Mercy ID: V-02937-22
Encounter Date: 11/19/2008
Last: Anderson
First: James
DOB: 06/18/2007
County: Clayton
Street: 1219 Marquis Way
City: Morrow
State: GA

Zip

30260-

Cell

(404) 798-9824

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Maria Puon	03/09/1975	Mexico
Father	Seborn Anderson	03/18/1978	USA
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: N/A
Grade: N/A
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