Pancho - CHA-MOI-85

Code: CHA-MOI-85
Mercy ID: V-02092-02
Encounter Date: 11/08/2005
Last: Chavez
First: Moises
DOB: 08/18/1983
County: Dekalb
Street: 2529 Skyland Apt A
City: Atlanta
State: GA

Zip

30319-

Home

(678) 789-0594

Family Status

Two parent family w/children

COB

Mexico

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