Pancho - MOL-VIC-05

Code: MOL-VIC-05
Mercy ID: V-03033-21
Encounter Date: 04/29/2009
Last: Molina
First: Victor
DOB: 08/29/2005
County: Fulton
Street: 651 Morosco Dr Apt. D
City: Atlanta
State: GA

Zip

30324-

Cell

(404) 957-6082

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Ana L. Chula Cruz	06/27/1983	Mexico
Father	Victor M. Molina Bailon	N/A	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother w/Stepfather
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