Pancho - VID-CRU-78

Code: VID-CRU-78
Mercy ID: V-01839-02
Encounter Date: 03/01/2005
Last: Cruz
First: Vidal
DOB: 08/29/1978
County: Gwinnett
Street: 3213 Quail Lakevilla SE #A
City: Norcross
State: GA

Zip

30093-

Home

(678) 873-2186

Family Status

Adult coupie-no 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: E. Lavizzo