Pancho - BEN-VIC-65

Code: BEN-VIC-65
Mercy ID: V-01325-02
Encounter Date: 08/19/2003
Last: Benitez
First: Victor
DOB: 03/29/1965
County: Cobb
Street: 5881 S Gordon Rd.
City: Austell
State: GA

Zip

30168-

Home

(770) 739-8033

Cell

(678) 234-8309

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Doubling Up

Education Level

Grade 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: R. Miranda
Data Entry: K. Aleman