JUA-AXE-08

Code
JUA-AXE-08
Mercy ID
V-03153-21
Encounter Date
08/25/2009
Last
Juarez
First
Axel
DOB
05/21/2008
County
Dekalb
Street
2589 New Bedford Way
City
Atlanta
State
GA
Zip
30345-
Cell
(678) 595-5875
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 Gladys Villa 08/02/1985 Ecuador
Father Cresencio juarez 05/31/1983 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Parents
Name of School
N/A
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. Perez
Data Entry
J. Manzo