Pancho - SAN-BEN-03

Code: SAN-BEN-03
Mercy ID: V-02413-22
Encounter Date: 02/28/2007
Last: Sandoval
First: Benjamin
DOB: 07/26/2003
County: Fulton
Street: 12008 Gardner Dr.
City: Alpharetta
State: GA

Zip

30004-

Cell

(678) 549-6463

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Doubling Up

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Blanca Mayo	06/19/1971	Mexico
Father	Jose Luis Sandoval	09/12/1970	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Henry Spring Elem
Grade: Kinder
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: C. Martinez
Data Entry: J. Manzo