Pancho - VEL-JOS-03

Code: VEL-JOS-03
Mercy ID: V-02962-21
Encounter Date: 12/10/2008
Last: Velasquez
First: Jose
DOB: 06/16/2003
County: Fulton
Street: 295 Windy River Dr. Apt. L
City: Atlanta
State: GA

Zip

30350-

Home

(404) 748-2805

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Doubling Up

Education Level

Preschool

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Florinda Silverio	01/18/1969	Mexico
Father	Amado Velasquez	06/09/1962	Mexico
Step Parent	N/A	N/A	N/A

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