Pancho - MEN-RAY-07

Code: MEN-RAY-07
Mercy ID: V-03110-21
Encounter Date: 07/08/2009
Last: Mendoza
First: Raymundo
DOB: 02/13/2007
County: Dekalb
Street: 2181 Dresden Dr.
City: Atlanta
State: GA

Zip

30341-

Cell

(678) 913-4801

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	Herminia Cuevas	01/13/1977	Mexico
Father	Raymundo Mendoza	01/07/1978	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: YES
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: YES

Intake: C. Martinez
Data Entry: J. Manzo