Pancho - ANT-ISR-95

Code: ANT-ISR-95
Mercy ID: V-01830-22
Encounter Date: 03/02/2005
Last: Antunez
First: Israel
DOB: 12/25/1995
County: Cobb
Street: 1101 Gallery Lane
City: Smyrna
State: GA

Zip

30080-

Home

(770) 801-8898

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Not Homeless

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Catalina Uriostegui	04/30/1970	Mexico
Father	Nemesio Antunez	10/31/1970	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: N/A
Grade: 3rd.
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