Pancho - ORT-AND-02

Code: ORT-AND-02
Mercy ID: V-03297-22
Encounter Date: 04/14/2010
Last: Ortiz
First: Andy
DOB: 09/06/2002
County: Gwinnett
Street: 696 Killian Hill Rd.
City: Lilburn
State: GA

Zip

30047-

Cell

(404) 399-5581

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	Maria Morales	06/02/1976	Mexico
Father	Nicolas Ortiz	05/09/1974	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Knight Elem.
Grade: 1st.
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