Pancho - MAY-SAC-60

Code: MAY-SAC-60
Mercy ID: V-00054-02
Encounter Date: 05/04/2000
Last: Maya
First: Sacramento
DOB: 11/23/1960
County: Dekalb
Street: 23 Chaffield Dr. Apt. A2
City: Stone Mt.
State: GA

Zip

30083-

Home

(770) 465-4027

Family Status

Two parent family w/children

COB

Mexico

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: Y. Garcia