Pancho - GON-MAR-79

Code: GON-MAR-79
Mercy ID: V-02095-02
Encounter Date: 01/03/2006
Last: Gonzalez
First: Marco antonio
DOB: 05/10/1979
County: Dekalb
Street: 3180 Clairmont Rd Apt 704
City: Atlanta
State: GA

Zip

30329-

Cell

(678) 913-6040

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Other

Education Level

College Degree

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: F. Perez
Data Entry: R. Gonzalez