Pancho - VAR-JOS-77

Code: VAR-JOS-77
Mercy ID: V-00629-02
Encounter Date: 08/07/2001
Last: Vargas
First: Jose
DOB: 01/15/1977
County: Dekalb
Street: 1251 Pounds Lane
City: Clarkston
State: GA

Zip

30021-

Home

(404) 296-4120

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Doubling Up

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: R. Miranda
Data Entry: K. Aleman