Pancho - GAY-VIC-54

Code: GAY-VIC-54
Mercy ID: V-01035-02
Encounter Date: 05/06/2003
Last: Gaytan
First: Victor
DOB: 09/12/1954
County: Dekalb
Street: 3658 Buford Hwy L-6
City: Atlanta
State: GA

Zip

30329-

Home

(404) 486-4280

Family Status

Two parent family w/children

COB

Guatemala

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