Pancho - CHA-JOS-76

Code: CHA-JOS-76
Mercy ID: V-00301-02
Encounter Date: 10/03/2000
Last: Chavez
First: Jose
DOB: 07/17/1976
County: Cobb
Street: 8242 durlee lane apt 109
City: Dougville
State: GA

Zip

30134-

Home

(678) 838-4924

Family Status

Two parent family w/children

COB

USA

Gender

Male

Housing

Doubling Up

Education Level

High school graduate

Home Owner

YES

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: R. Miranda
Data Entry: S. Aviña