Pancho - BRI-MIC-01

Code: BRI-MIC-01
Mercy ID: V-02671-12
Encounter Date: 12/16/2009
Last: Brito
First: Mitchael
DOB: 10/17/2001
County: Dekalb
Street: 2761 Jaguar Dr.
City: Ellenwood
State: GA

Zip

30294-

Home

(404) 243-3533

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Maria A Brito	09/19/1981	Mexico
Father	Felipe Brito	06/08/1954	Mexico
Step Parent	N/A	N/A	N/A

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

Intake: C. Martinez
Data Entry: J. Manzo