Pancho - ROM-MAR-96

Code: ROM-MAR-96
Mercy ID: V-02952-21
Encounter Date: 04/29/2009
Last: Roman
First: Mario
DOB: 09/01/1996
County: Fulton
Street: 201 Northwood Dr. Apt. C-5
City: Sandy springs
State: GA

Zip

30342-

Cell

(404) 438-5930

Family Status

Child/Youth

COB

Mexico

Gender

Male Child

Housing

Single Family

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Socorro Bahena	06/27/1969	Mexico
Father	N/A	N/A	Mexico
Step Parent	Silvestre Carnall	06/20/1965	Mexico

Driver: No
Relative: No
Stranger: No
Lives With: Mother w/Stepfather
Name of School: Ridgeview Middle
Grade: 6th.
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