Pancho - DEL-ADR-06

Code: DEL-ADR-06
Mercy ID: V-03067-22
Encounter Date: 09/02/2009
Last: Del carmen
First: Adrian
DOB: 06/08/2006
County: Fulton
Street: 940 Singing Hills Dr.
City: Roswell
State: GA

Zip

30076-

Home

(770) 998-6914

Cell

(777) 082-7379

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	Roas E Chavez	08/21/1983	Mexico
Father	Felipe Del Carmen	10/16/1979	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Father
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