BEN-DER-06

Code
BEN-DER-06
Mercy ID
V-03396-22
Encounter Date
09/29/2010
Last
Benites
First
Derrick
DOB
12/19/2006
County
Dekalb
Street
1512 Brook Ct.
City
Doraville
State
GA
Zip
30340-
Cell
(770) 256-4083
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Single Family
Education Level
Child, not in school
Home Owner
YES

Parents Information

Name DOB COB
Mother Hermenegilda Benitez 09/30/1980 Mexico
Father N/A N/A Mexico
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

DOY PERMISO
Authoritation Parent
No
Authoritation Child
No
DOY PERMISO
No
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
Volunteer
Data Entry
J. Manzo