Pancho - POP-TOM-03

Code: POP-TOM-03
Mercy ID: V-01197-22
Encounter Date: 07/07/2004
Last: Popoca rodriguez
First: Tomas
DOB: 06/10/2003
County: Gwinnett
Street: 3236 Chapel Lane
City: Atlanta
State: GA

Zip

30360-

Home

(770) 368-1494

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Elena Rodriguez	09/15/1969	Mexico
Father	N/A	N/A	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: N/A
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