Pancho - CRU-ENR-04

Code: CRU-ENR-04
Mercy ID: V-02997-21
Encounter Date: 03/25/2009
Last: Cruz
First: Enrique
DOB: 12/10/2004
County: Rockdale
Street: 146 West Meadow
City: Coneys
State: GA

Zip

30012-

Home

(770) 593-1447

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Single Family

Education Level

Preschool

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Flor Blancas	05/29/1981	Mexico
Father	Francisco Cruz	08/30/1978	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: both parents
Name of School: Head Start
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: C. Martinez
Data Entry: J. Manzo