Pancho - MAR-SYN-77

Code: MAR-SYN-77
Mercy ID: V-02055-02
Encounter Date: 10/11/2005
Last: Martinez
First: Ynocencio
DOB: 06/22/1977
County: Fulton
Street: 66 Northwood Dr. Apt 138
City: Atlanta
State: GA

Zip

30342-

Home

(404) 256-3414

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: R. Gonzalez