Pancho - FER-KEV-02

Code: FER-KEV-02
Mercy ID: V-02233-21
Encounter Date: 05/17/2006
Last: Fernandez
First: Kevin
DOB: 06/07/2002
County: Dekalb
Street: 3160 Buford Hwy #F-1
City: Atlanta
State: GA

Zip

30329-

Home

(404) 484-7147

Family Status

Attached youth

COB

USA

Gender

Male Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Guadalupe Fernandez	03/07/1983	Mexico
Father	Calletano Lopez	08/07/1972	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
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: R. Gonzalez
Data Entry: R. Gonzalez