Pancho - MON-MAR-98

Code: MON-MAR-98
Mercy ID: V-03156-21
Encounter Date: 10/14/2009
Last: Monroy
First: Mark
DOB: 09/12/1998
County: Douglass
Street: 4486 Cherokee Dr. L- 56
City: Douglasville
State: GA

Zip

30134-

Cell

(404) 483-8935

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	Blanca Garcia	04/27/1973	Mexico
Father	Armando Godoy	08/18/1968	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Easid Elem.
Grade: 5th.
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