Pancho - MAR-LEO-78

Code: MAR-LEO-78
Mercy ID: V-02076-02
Encounter Date: 11/08/2005
Last: Marin
First: Leonardo
DOB: 11/06/1978
County: Fulton
Street: 364 Clydecole Rd
City: Dallas
State: GA

Zip

30157-

Home

(404) 379-1483

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