Pancho - FRA-BLA-70

Code: FRA-BLA-70
Mercy ID: V-00062-02
Encounter Date: 01/16/1996
Last: Fraire
First: Blas
DOB: 02/03/1970
County: Cobb
Street: 410 Watermand St.
City: Marietta
State: GA

Zip

30060-

Home

(770) 419-7597

Family Status

Adult coupie-no children

COB

Mexico

Gender

Male

Housing

Other

Education Level

some high school

Home Owner

No

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. Manzo
Data Entry: K. Aleman