Pancho - TIE-CHR-02

Code: TIE-CHR-02
Mercy ID: V-00591-21
Encounter Date: 01/28/2009
Last: Tierrafria
First: Christhofer
DOB: 09/14/2002
County: Fulton
Street: 2520 Jonesboro Rd. L-A- 35
City: Atlanta
State: GA

Zip

30315-

Cell

(404) 569-7559

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Single Family

Education Level

Preschool

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Irene Rivas	04/08/1980	Mexico
Father	Israel Tierrafria	01/19/1976	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Humphry Elem.
Grade: Kinder
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