Pancho - DOM-LEO-74

Code: DOM-LEO-74
Mercy ID: V-00313-02
Encounter Date: 12/05/2000
Last: Dominguez
First: Leonel
DOB: 11/27/1974
County: Fulton
Street: 5320 Roswell Rd. #1-3
City: Atlanta
State: GA

Zip

30342-

Home

(404) 303-7149

Cell

(404) 303-7149

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Doubling Up

Education Level

Preschool

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: R. Miranda
Data Entry: K. Aleman