Pancho - MER-BRY-94

Code: MER-BRY-94
Mercy ID: V-01143-22
Encounter Date: 07/30/2003
Last: Merino
First: Brian
DOB: 08/30/1994
County: Gwinnett
Street: 1355 Graves RD. Apt. 4-89
City: Norcross
State: GA

Zip

30093-

Home

(404) 292-1539

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Not Homeless

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Rosa I. Campos	03/09/1993	El Salvador
Father	Luis Merino	N/A	El Salvador
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: N/A
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