Pancho - SUA-BEN-02

Code: SUA-BEN-02
Mercy ID: V-00200-21
Encounter Date: 08/07/2002
Last: Suarez
First: Benjamin jr
DOB: 05/26/2002
County: Cobb
Street: 6780 Mableton Prk way Lot 49
City: Mableton
State: GA

Zip

30126-

Home

(770) 746-3490

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Teresa Suarez	02/28/1971	Mexico
Father	Benjamin Suarez	04/01/1969	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: Y. Garcia
Data Entry: K. Aleman