Pancho - LEY-SAN-73

Code: LEY-SAN-73
Mercy ID: V-00943-02
Encounter Date: 09/28/2004
Last: Leyva
First: Santiago
DOB: 01/10/1973
County: Dekalb
Street: 6942 Magnolia Park Dr.
City: Norcross
State: GA

Zip

30093-

Home

(770) 896-6807

Family Status

Single adult

COB

Mexico

Gender

Male

Housing

Doubling Up

Education Level

Preschool

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