GON-VIC-05

Code
GON-VIC-05
Mercy ID
V-03082-21
Encounter Date
06/03/2009
Last
Gonzalez
First
Victor manuel
DOB
05/12/2005
County
Dekalb
Street
3046 Clairmont Road Apt. G
City
Atlanta
State
GA
Zip
30329-
Cell
(404) 246-9631
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Doubling Up
Education Level
Preschool
Home Owner
YES

Parents Information

Name DOB COB
Mother Rosa maria Sanchez 12/15/1983 Mexico
Father Victor A. Gonzalez 12/13/1984 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
Medical Alert
NOTES
Astma
Lives With
Parents
Name of School
Sagamore Hills
Grade
N/A
Who Can't Pickup the Child

Media

NO DOY PERMISO
Authoritation Parent
No
Authoritation Child
No
DOY PERMISO
No
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
J. Manzo
Data Entry
J. Manzo