Pancho - GUS-SAN-97

Code: GUS-SAN-97
Mercy ID: V-03136-23
Encounter Date: 10/17/2010
Last: Sanchez
First: Gustavo
DOB: 12/31/1997
County: Cobb
Street: 388 Phillips Dr.
City: Marietta
State: GA

Zip

30060-

Cell

(678) 663-7453

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Single Family

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Evangelina Rodriguez	02/07/1974	Mexico
Father	Gustavo Sanchez	11/14/1971	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Six Grade Academy
Grade: 6th.
Who Can't Pickup the Child
Authoritation Parent: YES
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: C. Martinez
Data Entry: J. Manzo