Pancho - ORT-SEB-01

Code: ORT-SEB-01
Mercy ID: V-00002-41
Encounter Date: 04/11/2002
Last: Ortiz
First: Sebastian
DOB: 11/04/2001
County: Fulton
Street: 5320 Roswell Rd. Apt K-2
City: Atlanta
State: GA

Zip

30342-

Home

(404) 255-9698

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Nallely Ortiz	06/01/1984	Mexico
Father	Eduardo Velazquez	N/A	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
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: K. Aleman