Pancho - RIV-ROB-03

Code: RIV-ROB-03
Mercy ID: V-01734-21
Encounter Date: 10/27/2004
Last: Rivera
First: Roberto
DOB: 04/01/2003
County: Gwinnett
Street: 2640 Borrell Court
City: Kennesaw
State: GA

Zip

30144-

Home

(770) 572-1736

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	Natividad Guzman	12/14/1976	Mexico
Father	Roberto Rivera	09/11/1976	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: N/A
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