Pancho - VEG-BRY-01

Code: VEG-BRY-01
Mercy ID: V-02862-21
Encounter Date: 08/06/2008
Last: Garcia
First: Bryan
DOB: 05/09/2001
County: Gwinnett
Street: 6148 Susan Lane
City: Doraville
State: GA

Zip

30340-

Cell

(678) 668-0211

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Single Family

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Reynalda Vega	02/16/1981	USA
Father	Moises Roman	08/28/1982	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother w/Stepfather
Name of School: Susan istripling
Grade: 2nd.
Who Can't Pickup the Child
Authoritation Parent: YES
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: YES
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: C. Martinez
Data Entry: J. Manzo