Pancho - SAL-NER-69

Code: SAL-NER-69
Mercy ID: V-00143-02
Encounter Date: 03/21/2000
Last: Salazar
First: Nery
DOB: 12/12/1969
County: Clayton
Street: 1466 rockcut Rd Apt B-2
City: Forest park
State: GA

Zip

30297-

Home

(404) 361-0765

Family Status

Adult coupie-no children

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: D. Gomez