Pancho - BUE-DER-98

Code: BUE-DER-98
Mercy ID: V-00017-22
Encounter Date: 01/05/2000
Last: Buenaventura
First: Derian
DOB: 05/20/1998
County: Fulton
Street: 4745 Buford Hwy Apt. C
City: Chamblee
State: GA

Zip

30321-

Home

(678) 547-0850

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Veronica Flores	12/31/1980	Mexico
Father	Leonardo Buenaventura	08/22/1967	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: J. Manzo
Data Entry: K. Aleman