Pancho - MAR-MAU-66

Code: MAR-MAU-66
Mercy ID: V-01095-02
Encounter Date: 10/26/1997
Last: Mariche
First: Maurino
DOB: 06/10/1966
County: Other
Street: 00000
City: 0000
State: GA

Zip

00000-0000

Home

(770) 665-2941

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Other

Education Level

College Degree

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: K. Aleman