Pancho - FON-MAR-72

Code: FON-MAR-72
Mercy ID: V-00693-02
Encounter Date: 11/27/2001
Last: Fontaine
First: Marco
DOB: 09/18/1972
County: Cobb
Street: 7740 Poppy Dr.
City: Winston
State: GA

Zip

30187-

Home

(770) 942-8285

Cell

(770) 980-1386

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Doubling Up

Education Level

High school graduate

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