Pancho - SAN-IVA-05

Code: SAN-IVA-05
Mercy ID: V-03053-21
Encounter Date: 04/29/2009
Last: Sanchez
First: Ivan
DOB: 05/27/2005
County: Dekalb
Street: 1016 Brookview Ave.
City: Doraville
State: GA

Zip

30340-

Cell

(770) 882-7396

Family Status

Child/Youth

COB

USA

Gender

Male

Housing

Single Family

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Rosy Sanchez	09/22/1973	Mexico
Father	Alejandro Sanchez	05/17/1973	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: N/A
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