Pancho - SUG-FER-85

Code: SUG-FER-85
Mercy ID: V-03033-02
Encounter Date: 04/14/2009
Last: Sugia
First: Fernando
DOB: 11/05/1985
County: Fulton
Street: 651 Morozco Dr. Aptl D
City: Atlanta
State: GA

Zip

30324-

Cell

(404) 957-6082

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Doubling Up

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