Pancho - MON-DAV-01

Code: MON-DAV-01
Mercy ID: V-03345-21
Encounter Date: 06/16/2010
Last: Mondragon
First: David
DOB: 10/31/2001
County: Dekalb
Street: 2111 Gables Way
City: Atlanta
State: GA

Zip

30329-

Cell

(678) 368-2359

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	Miceli Mondragon	10/16/1971	Mexico
Father	Abel Mondragon	08/01/1971	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Sagamore Hills
Grade: 3rd.
Who Can't Pickup the Child
Authoritation Parent: YES
Authoritation Child: No
DOY PERMISO: YES
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: C. Martinez
Data Entry: J. Manzo