Pancho - CHI-SEL-84

Code: CHI-SEL-84
Mercy ID: V-01946-02
Encounter Date: 06/21/2005
Last: Chirino
First: Selvin
DOB: 07/03/1984
County: Fulton
Street: 3781 Mableton Apt #3
City: Atlanta
State: GA

Zip

30318-

Home

(678) 365-7435

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