Pancho - AVE-FEL-76

Code: AVE-FEL-76
Mercy ID: V-02057-02
Encounter Date: 10/04/2005
Last: Avecillas
First: Felipe
DOB: 06/24/1976
County: Gwinnett
Street: 5910 Hickort Springs Dr.
City: Norcross
State: GA

Zip

30071-

Home

(770) 242-8145

Family Status

Two parent family w/children

COB

Ecuador

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