Pancho - PER-SER-76

Code: PER-SER-76
Mercy ID: V-01626-02
Encounter Date: 06/15/2004
Last: Perez
First: Jose sergio
DOB: 10/25/1976
County: Fulton
Street: 53 Longview Dr.
City: Eastpoint
State: GA

Zip

30344-

Home

(404) 312-9895

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Doubling Up

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: R. Miranda
Data Entry: K. Aleman