Pancho - CRI-MOD-01

Code: CRI-MOD-01
Mercy ID: V-02489-21
Encounter Date: 06/13/2007
Last: Crisanto
First: Modesto
DOB: 12/25/2000
County: Cobb
Street: 1900 South Cobb Dr. #B-9
City: Marietta
State: GA

Zip

30060-

Cell

(678) 598-8487

Family Status

Child/Youth

COB

Mexico

Gender

Male Child

Housing

Single Family

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Cecilia Crisantos	08/16/1981	Mexico
Father	N/A	N/A	N/A
Step Parent	Vicente Caro	08/12/1979	Mexico

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Green Acres Elem
Grade: 2nd.
Who Can't Pickup the Child
Authoritation Parent: YES
Authoritation Child: No
DOY PERMISO: YES
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: Y. Garcia
Data Entry: J. Manzo