Pancho - ANT-MAR-66

Code: ANT-MAR-66
Mercy ID: V-00133-02
Encounter Date: 02/16/2000
Last: Antonio
First: Marcos
DOB: 03/04/1966
County: Dekalb
Street: 3450 Evans Rd Ad103 B
City: Chamblee
State: GA

Zip

30341-

Home

(770) 493-7661

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Not Homeless

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: R. Miranda
Data Entry: D. Gomez