Pancho - SAN-EBE-97

Code: SAN-EBE-97
Mercy ID: V-00318-25
Encounter Date: 10/27/2000
Last: Santana
First: Everardo
DOB: 11/29/1997
County: Rockdale
Street: 2195 West High Tower Trail
City: Conyers
State: GA

Zip

30012-

Cell

(678) 349-8063

Family Status

Child/Youth

COB

Mexico

Gender

Male Child

Housing

Doubling Up

Education Level

High school graduate

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Norma Segura	01/04/1960	Mexico
Father	Pablo Santana	07/07/1954	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
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: K. Aleman
Data Entry: S. Aviña