Pancho - VAS-URB-69

Code: VAS-URB-69
Mercy ID: V-02226-02
Encounter Date: 04/24/2006
Last: Vasquez
First: Urbano
DOB: 05/25/1969
County: Dekalb
Street: 3421 Cumberland Apt H
City: Chamblee
State: GA

Zip

30341-

Cell

(678) 598-0835

Family Status

Single adult

COB

Guatemala

Gender

Male

Housing

Doubling Up

Education Level

Grade 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: F. Perez
Data Entry: R. Gonzalez