Pancho - CAR-JOS-80

Code: CAR-JOS-80
Mercy ID: V-02114-02
Encounter Date: 01/03/2006
Last: Cardozo
First: Jose domingo
DOB: 11/21/1980
County: Fulton
Street: 970 Windy Hill Rd Apt 11-G
City: Smyrna
State: GA

Zip

30080-

Home

(770) 434-7608

Cell

(678) 794-6374

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Other

Education Level

Some College

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: F. Perez
Data Entry: R. Gonzalez