Pancho - GOM-BRI-99

Code: GOM-BRI-99
Mercy ID: V-00929-21
Encounter Date: 05/22/2002
Last: Gomez
First: Bryan
DOB: 09/01/1999
County: Not given
Street: 6750 Peachtree Industrial Blvd. 2205
City: Atlanta
State: GA

Zip

30360-

Home

(404) 454-2231

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Carime Avellaneda	12/22/1972	Mexico
Father	Savino Gomez	12/22/1971	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