Pancho - MEN-ROG-74

Code: MEN-ROG-74
Mercy ID: V-00751-02
Encounter Date: 11/06/2001
Last: Mendoza
First: Rogelio
DOB: 08/03/1974
County: Gwinnett
Street: 5686 Hammond Dr.
City: Norcross
State: GA

Zip

30071-

Home

(770) 416-9165

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Doubling Up

Education Level

some high 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