Pancho - JIM-KEV-07

Code: JIM-KEV-07
Mercy ID: V-03191-21
Encounter Date: 10/21/2009
Last: Jimenez
First: Kevin
DOB: 05/26/2007
County: Clayton
Street: 444 Cedar Court
City: Riverdale
State: GA

Zip

30274-

Home

(770) 603-2717

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Single Family

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Martha Torrez	01/17/1974	Mexico
Father	Alvaro Jimenez	05/18/1973	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: No
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: C. Martinez
Data Entry: J. Manzo