Pancho - ORT-TOM-71

Code: ORT-TOM-71
Mercy ID: V-00016-02
Encounter Date: 10/13/1999
Last: Ortiz
First: Tomas
DOB: 09/22/1971
County: Cherokee
Street: 237 parck ave.
City: Woodstock
State: GA

Zip

30188-

Home

(770) 419-8931

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: J. Perilla
Data Entry: S. Aviña