Pancho - QUI-IVA-02

Code: QUI-IVA-02
Mercy ID: V-03041-21
Encounter Date: 04/15/2009
Last: Quintero
First: Omar
DOB: 01/11/2002
County: Fulton
Street: 221 Woodcreek court
City: Roswell
State: GA

Zip

30076-

Cell

(404) 704-2660

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	Winnie Bedolla	09/18/1979	Mexico
Father	Omar Quintero	N/A	Mexico
Step Parent	David Zamora	09/27/1979	Mexico

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Norton Park
Grade: 1st.
Who Can't Pickup the Child
Authoritation Parent: YES
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: YES

Intake: C. Martinez
Data Entry: J. Manzo