Pancho - REY-LEO-19

Code: REY-LEO-19
Mercy ID: V-01557-02
Encounter Date: 05/04/2004
Last: Reyes
First: Leonel
DOB: 11/16/1972
County: Fulton
Street: 5684 Goldon Dr.
City: Forest park
State: GA

Zip

30294-

Home

(678) 886-1760

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: K. Aleman