Pancho - ROS-GRE-78

Code: ROS-GRE-78
Mercy ID: V-00035-02
Encounter Date: 09/08/1999
Last: Ross
First: Gregory
DOB: 12/29/1978
County: Fulton
Street: 883 tahoe Way # I
City: Roswell
State: GA

Zip

30076-

Home

(770) 998-0664

Family Status

Adult coupie-no children

COB

USA

Gender

Male

Housing

Other

Education Level

Post Grad Degree

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	N/A	N/A	N/A
Father	N/A	N/A	N/A
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: J. Perilla
Data Entry: D. Gomez