Pancho - CHA-BRI-92

Code: CHA-BRI-92
Mercy ID: V-00684-23
Encounter Date: 09/19/2001
Last: Chavez
First: Brian
DOB: 11/24/1992
County: Cobb
Street: 3510 Buford Hwy Apt. WF
City: Atllanta
State: GA

Zip

30329-

Home

(678) 488-9405

Family Status

Attached youth

COB

Guatemala

Gender

Male Child

Housing

Doubling Up

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Silvia Castillo	03/18/1967	Guatemala
Father	Jose Chavez	07/25/1959	Guatemala
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Montclair Elementary
Grade: 3rd.
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