Pancho - PIA-CHR-00

Code: PIA-CHR-00
Mercy ID: V-03163-21
Encounter Date: 09/23/2009
Last: Pia
First: Christian
DOB: 09/18/2000
County: Dekalb
Street: 17 Clairview Dr.
City: Chamblee
State: GA

Zip

30341-

Cell

(678) 592-8010

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Doubling Up

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Maria Lemus	08/28/1962	Guatemala
Father	Victoriano Pia	11/17/1965	Guatemala
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Cary Raynolds Elem
Grade: 3rd.
Who Can't Pickup the Child
Authoritation Parent: No
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: C. Martinez
Data Entry: J. Manzo