Pancho - FLO-MAR-01

Code: FLO-MAR-01
Mercy ID: V-00953-22
Encounter Date: 06/26/2002
Last: Flores
First: Marco antonio
DOB: 06/11/2001
County: Hall
Street: 5565 Mulberry St. Apt. A-S
City: Flowery branch
State: GA

Zip

30542-

Cell

(678) 887-2941

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Single Family

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Susana Ventura	08/10/1973	Mexico
Father	Marco Antonio Flores	06/13/1977	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Flowery Branch elem
Grade: 3rd.
Who Can't Pickup the Child
Authoritation Parent: YES
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: YES
Limitado Caminar Latino: No

Intake: Y. Garcia
Data Entry: K. Aleman