Pancho - RAM-MAR-72

Code: RAM-MAR-72
Mercy ID: V-01368-02
Encounter Date: 09/30/2003
Last: Ramirez
First: Mardoqueo
DOB: 09/21/1972
County: Dekalb
Street: 3515 Cumberland Dr. Apt #5
City: Chamblee
State: GA

Zip

30341-

Home

(770) 458-0638

Family Status

Adult coupie-no children

COB

Mexico

Gender

Male

Housing

Doubling Up

Education Level

Preschool

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