Pancho - RAM-GUS-02

Code: RAM-GUS-02
Mercy ID: V-01913-21
Encounter Date: 07/06/2005
Last: Ramirez
First: Gustavo
DOB: 08/10/2002
County: Dekalb
Street: 3282 Scarlet Rd. A
City: Atlanta
State: GA

Zip

30340-

Home

(770) 409-1578

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Elda Mejia	07/29/1978	Mexico
Father	Gustavo Ramirez	07/21/1977	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