Pancho - ARC-JOS-65

Code: ARC-JOS-65
Mercy ID: V-00871-02
Encounter Date: 04/30/2002
Last: Arce
First: Jose gustavo
DOB: 01/22/1965
County: Dekalb
Street: 2903 Alcoa Ct.
City: Chamblee
State: GA

Zip

30341-

Home

(678) 530-2075

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