Pancho - RIV-EDG-01

Code: RIV-EDG-01
Mercy ID: V-02553-21
Encounter Date: 07/25/2007
Last: Rivera
First: Edgar
DOB: 05/04/2001
County: Dekalb
Street: 4072 Doral Dr.
City: Atlanta
State: GA

Zip

30360-

Cell

(678) 913-4187

Family Status

Attached youth

COB

USA

Gender

Male Child

Housing

Doubling Up

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Maribel Ariza	08/10/1982	Mexico
Father	Edgar Rivera	05/14/1978	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: High Tower
Grade: 1st.
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: C. Martinez
Data Entry: J. Manzo