Pancho - CHA-WIL-75

Code: CHA-WIL-75
Mercy ID: V-02080-02
Encounter Date: 10/18/2005
Last: Chavez
First: Wilson
DOB: 06/03/1975
County: Dekalb
Street: 3419 Cumberland Ct. H4
City: Chamblee
State: GA

Zip

30341-

Home

(404) 935-2754

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: R. Miranda
Data Entry: R. Gonzalez