Pancho - SAL-JOS-66

Code: SAL-JOS-66
Mercy ID: V-01761-02
Encounter Date: 11/30/2004
Last: Salas
First: Jose hilario
DOB: 09/28/1966
County: Cobb
Street: 546 Virginia Place
City: Marietta
State: GA

Zip

30067-

Home

(404) 933-6363

Family Status

Two parent family w/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