Pancho - GUZ-DAN-07

Code: GUZ-DAN-07
Mercy ID: V-03270-23
Encounter Date: 08/16/2010
Last: Guzman
First: Daniel
DOB: 12/22/2007
County: Fulton
Street: 5555 Roswell Rd. A-4
City: Atlanta
State: GA

Zip

30342-

Cell

(678) 558-7287

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Doubling Up

Education Level

Preschool

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Leticia Carmona	08/12/1978	Mexico
Father	Severo Guzman	10/26/1978	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Lake Forest Elem.
Grade: Pre-K
Who Can't Pickup the Child: Severo Guzman - DAD
Authoritation Parent: No
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: J. Manzo
Data Entry: J. Manzo