Pancho - CAM-PAT-63

Code: CAM-PAT-63
Mercy ID: V-00039-02
Encounter Date: 07/23/1999
Last: Campuzano
First: Patricio
DOB: 03/17/1963
County: Fulton
Street: 1190 Lowel Lane Apt. 1190
City: Roswell
State: GA

Zip

30076-

Home

(770) 518-6936

Family Status

Single parent w/children

COB

Mexico

Gender

Male

Housing

Not Homeless

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: F. Perez
Data Entry: S. Aviña