BLA-ZAC-03

Code
BLA-ZAC-03
Mercy ID
V-01143-23
Encounter Date
07/30/2003
Last
Blanco
First
Zacarias
DOB
02/01/2003
County
Gwinnett
Street
1355 Graves Rd. Apt. 4-89
City
Norcross
State
GA
Zip
30093-
Home
(000) 000-0000
Family Status
Attached youth
COB
Mexico
Gender
Male Child
Housing
Not Homeless
Education Level
Child, not in school
Home Owner
YES

Parents Information

Name DOB COB
Mother Rosa I. Campos 03/09/1973 El Salvador
Father Zacarias Blanco 12/05/1975 El Salvador
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Mother
Name of School
N/A
Grade
N/A
Who Can't Pickup the Child

Media

NO DOY PERMISO
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