Pancho - PER-JOS-85

Code: PER-JOS-85
Mercy ID: V-03442-02
Encounter Date: 11/02/2010
Last: Perez
First: Jose
DOB: 06/21/1985
County: Fulton
Street: 3815 MLK Union Dr. F-5
City: Atlanta
State: GA

Zip

30331-

Cell

(678) 882-9463

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Single Family

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: J. Manzo
Data Entry: J. Manzo