Pancho - BUS-EDG-01

Code: BUS-EDG-01
Mercy ID: V-01244-21
Encounter Date: 07/09/2003
Last: Bustos
First: Edgar
DOB: 11/08/2001
County: Fulton
Street: 816 Tahoe Ridge
City: Roswell
State: GA

Zip

30076-

Home

(770) 640-9001

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	Fabiola Diaz	10/12/1980	Mexico
Father	Edgar Bustos	02/20/1980	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