Pancho - TEL-JOS-79

Code: TEL-JOS-79
Mercy ID: V-01158-02
Encounter Date: 03/12/2003
Last: Tellez
First: Jose guadalupe
DOB: 12/12/1979
County: Dekalb
Street: 1728 Beardown Trl
City: Jonesboro
State: GA

Zip

30328-

Home

(678) 474-1229

Family Status

Adult coupie-no children

COB

Mexico

Gender

Male

Housing

Doubling Up

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: R. Miranda
Data Entry: K. Aleman