Pancho - COR-ISM-77

Code: COR-ISM-77
Mercy ID: V-02268-02
Encounter Date: 06/19/2006
Last: Cortez
First: Ismael
DOB: 12/12/1977
County: Dekalb
Street: 3510 Buford Hwy G-4
City: Atlanta
State: GA

Zip

30329-

Home

(678) 368-7055

Cell

(404) 484-2287

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