Pancho - ROS-EUS-62

Code: ROS-EUS-62
Mercy ID: V-01261-02
Encounter Date: 07/01/2003
Last: Rosario
First: Eusebio luis
DOB: 11/29/1962
County: Dekalb
Street: 414 Briarlake Ct.
City: Atlanta
State: GA

Zip

30345-

Home

(404) 634-5945

Family Status

Two parent family w/children

COB

Dominican Rep

Gender

Male

Housing

Doubling Up

Education Level

some high school

Home Owner

YES

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