Pancho - SIM-GEO-03

Code: SIM-GEO-03
Mercy ID: V-02302-21
Encounter Date: 08/09/2006
Last: Simmons
First: George
DOB: 12/09/2003
County: Fulton
Street: 3385 Atkins Rd.
City: Atlanta
State: GA

Zip

30331-

Home

(770) 317-7578

Family Status

Attached youth

COB

USA

Gender

Male Child

Housing

Transitional

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Dulce Idizalde	10/03/1970	Mexico
Father	George Simmons	10/04/1966	USA
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
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: J. Manzo
Data Entry: J. Manzo