Pancho - DIA-JOS-00

Code: DIA-JOS-00
Mercy ID: V-00881-22
Encounter Date: 03/27/2002
Last: Diaz
First: Jose luis
DOB: 10/23/2000
County: Dekalb
Street: 3534 Old Chamblee Tucker Rd. Apt 6
City: Doraville
State: GA

Zip

30340-

Home

(770) 908-8737

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	Irene Garzon	10/06/1964	Colombia
Father	Jose Luis Diaz	08/16/1964	Panamá
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: Y. Garcia
Data Entry: K. Aleman