CIS-JON-08

Code
CIS-JON-08
Mercy ID
O-00002-21
Encounter Date
03/31/2010
Last
Cisneros
First
Jonathan
DOB
06/25/2008
County
Gwinnett
Street
4183 Rufus Place
City
Doraville
State
GA
Zip
30340-
Cell
(404) 484-4294
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Doubling Up
Education Level
Child, not in school
Home Owner
YES

Parents Information

Name DOB COB
Mother Susana Arellano 05/03/1989 Mexico
Father Sergio Cisneros 09/28/1988 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Mother
Name of School
N/A
Grade
N/A
Who Can't Pickup the Child

Media

DOY PERMISO
Authoritation Parent
YES
Authoritation Child
No
DOY PERMISO
No
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
C. Martinez
Data Entry
J. Manzo