Pancho - BAL-JUA-72

Code: BAL-JUA-72
Mercy ID: B-00039-01
Encounter Date: 03/19/1997
Last: Baldera
First: Juan
DOB: 05/21/1972
County: Fulton
Street: Dutontaben way #5
City: Atlanta
State: GA

Zip

30098-

Home

(404) 352-3895

Family Status

Adult coupie-no children

COB

Mexico

Gender

Male

Housing

Not Homeless

Education Level

Other

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: K. Aleman