Pancho - DUR-WIL-66

Code: DUR-WIL-66
Mercy ID: V-01347-02
Encounter Date: 06/28/1999
Last: Duran
First: William
DOB: 09/04/1966
County: Dekalb
Street: 4658 Hairston Crossing Way
City: Stone mountain
State: GA

Zip

30083-

Home

(404) 297-8803

Family Status

Two parent family w/children

COB

Venezuela

Gender

Male

Housing

Doubling Up

Education Level

High school graduate

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