Pancho - SAL-LUI-76

Code: SAL-LUI-76
Mercy ID: V-01471-02
Encounter Date: 01/27/2004
Last: Salazar
First: Luis
DOB: 09/14/1976
County: Dekalb
Street: Jennifer Dr. NW #8
City: Lilburn
State: GA

Zip

30047-

Home

(770) 823-7261

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Doubling Up

Education Level

some high school

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: R. Miranda
Data Entry: K. Aleman