Pancho - FUE-CRI-08

Code: FUE-CRI-08
Mercy ID: V-03042-22
Encounter Date: 05/06/2009
Last: Fuentes
First: Cristopher
DOB: 04/04/2008
County: Fulton
Street: 5932 Kingsport Drive Apt. 149
City: Atlanta
State: GA

Zip

30342-

Home

(404) 725-7099

Cell

(678) 497-7824

Family Status

Two parent family w/children

COB

USA

Gender

Male Child

Housing

Single Family

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Cristina Rosas	07/25/1979	Mexico
Father	mario Fuentes	06/16/1973	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
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