Pancho - AVI-BRI-00

Code: AVI-BRI-00
Mercy ID: V-03087-21
Encounter Date: 06/10/2009
Last: Avila
First: Brian
DOB: 11/26/2000
County: Clayton
Street: 955 Pineglen Dr.
City: Forest park
State: GA

Zip

30297-

Home

(678) 759-0270

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	Leticia Avila	04/14/1975	Mexico
Father	Mario Avila Ventura	02/19/1975	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: BCG Elementary
Grade: 3rd.
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: C. Martinez
Data Entry: J. Manzo