Pancho - BOT-ERN-72

Code: BOT-ERN-72
Mercy ID: V-00959-02
Encounter Date: 06/04/2002
Last: Botello
First: Ernesto
DOB: 12/24/1972
County: Clayton
Street: 347 River Brook
City: Clayton
State: GA

Zip

30274-

Home

(770) 318-0373

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