SAN-JAK-08

Code
SAN-JAK-08
Mercy ID
V-03004-21
Encounter Date
02/25/2009
Last
Sanchez
First
Jack
DOB
08/04/2008
County
Dekalb
Street
2589 New Bedford Way NE
City
Atlanta
State
GA
Zip
30345-
Cell
(678) 856-9071
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Doubling Up
Education Level
Child, not in school
Home Owner
YES

Parents Information

Name DOB COB
Mother Blanca Villa 12/28/1978 Ecuador
Father Jose Sanchez 06/22/1981 Ecuador
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Mother
Name of School
N/A
Grade
N/A
Who Can't Pickup the Child

Media

NO DOY PERMISO
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