Pancho - OLA-MAU-64

Code: OLA-MAU-64
Mercy ID: V-01176-02
Encounter Date: 03/25/2003
Last: Olascuada
First: Mauricio
DOB: 09/22/1964
County: Fulton
Street: 1701Sandalwood Dr.
City: Atlanta
State: GA

Zip

30350-

Home

(770) 645-9670

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Doubling Up

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: R. Miranda
Data Entry: K. Aleman