Pancho - TAO-FOR-89

Code: TAO-FOR-89
Mercy ID: V-00039-21
Encounter Date: 01/12/2000
Last: Taboada
First: Fortino
DOB: 06/03/1989
County: Fulton
Street: 1190 Lowell Lane
City: Roswell
State: GA

Zip

30076-

Home

(770) 518-6936

Family Status

Child/Youth

COB

USA

Gender

Male

Housing

Single Family

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Rosa Taboada	01/04/1968	Mexico
Father	N/A	N/A	Mexico
Step Parent	Patricio Campuzano	03/17/1963	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother w/Stepfather
Name of School: Mimosa Elem
Grade: 4th.
Who Can't Pickup the Child: SOLO LO PUIEDE RECOGER LA MAMA
Authoritation Parent: No
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: J. Perez
Data Entry: J. Manzo