Pancho - VAL-JOS-62

Code: VAL-JOS-62
Mercy ID: V-02145-02
Encounter Date: 01/17/2006
Last: Valles
First: Jose orlando
DOB: 02/03/1962
County: Gwinnett
Street: 311 Angle Dr
City: Tucker
State: GA

Zip

30084-

Home

(770) 717-6285

Family Status

Two parent family w/children

COB

El Salvador

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: R. Gonzalez