Pancho - GON-JOS-77

Code: GON-JOS-77
Mercy ID: V-00078-02
Encounter Date: 08/20/1999
Last: Gonzalez
First: Jose
DOB: 12/12/1977
County: Cherokee
Street: 1212 Hwy92 #34
City: Acworth
State: GA

Zip

30102-

Family Status

Two parent family w/children

COB

Guatemala

Gender

Male

Housing

Doubling Up

Education Level

some high school

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: D. Gomez