Pancho - GON-JOR-99

Code: GON-JOR-99
Mercy ID: V-00281-23
Encounter Date: 09/13/2000
Last: Gonzalez
First: Jorge
DOB: 03/15/1999
County: Dekalb
Street: 4729 Buford Hwy apt. H
City: Chamblee
State: GA

Zip

30341-

Home

(770) 216-9932

Family Status

Attached youth

COB

USA

Gender

Male Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Carmelita Gonzalez	10/10/1962	Mexico
Father	Roberto Vaca	01/20/1965	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: K. Aleman
Data Entry: Y. Garcia