Pancho - URI-SER-75

Code: URI-SER-75
Mercy ID: V-03031-02
Encounter Date: 04/20/2009
Last: Uribe
First: Sergio
DOB: 10/03/1975
County: Dekalb
Street: 4605 Peachtree Place Parkway
City: Doraville
State: GA

Zip

30360-

Cell

(770) 873-8363

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Single Family

Education Level

some high 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: J. Manzo
Data Entry: J. Manzo