Pancho - ALV-CEC-44

Code: ALV-CEC-44
Mercy ID: B-00022-02
Encounter Date: 11/06/1996
Last: Alvarez
First: Cecilio
DOB: 05/22/1944
County: Other
Street: 2644 Balmar Dr.
City: Doraville
State: GA

Zip

30340-

Home

(000) 000-0000

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Other

Education Level

Other

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: J. Manzo
Data Entry: K. Aleman