Pancho - MAR-PED-73

Code: MAR-PED-73
Mercy ID: V-01970-02
Encounter Date: 07/19/2005
Last: Martinez
First: Pedro
DOB: 09/08/1973
County: Dekalb
Street: 3179 Shadow Walk Ln.
City: Tucker
State: GA

Zip

30084-

Home

(404) 867-4630

Family Status

Two parent family w/children

COB

Mexico

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: R. Miranda
Data Entry: K. Aleman