Pancho - COR-VIC-69

Code: COR-VIC-69
Mercy ID: V-00878-02
Encounter Date: 03/26/2002
Last: Cortez
First: Victor
DOB: 08/03/1969
County: Fulton
Street: 565 Dixie Lake Rd.
City: Union city
State: GA

Zip

30291-

Home

(770) 774-9549

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Doubling Up

Education Level

Grade school

Home Owner

YES

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