Pancho - FLO-SEL-80

Code: FLO-SEL-80
Mercy ID: V-02014-02
Encounter Date: 09/13/2005
Last: Flores
First: Selving
DOB: 01/31/1980
County: Dekalb
Street: 2953 N. Dekalb
City: Doraville
State: GA

Zip

30340-

Home

(678) 458-1909

Family Status

Two parent family w/children

COB

El Salvador

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: R. Gonzalez