Pancho - OVA-DIO-54

Code: OVA-DIO-54
Mercy ID: V-02098-02
Encounter Date: 11/22/2005
Last: Ovalles
First: Dionicio
DOB: 09/11/1954
County: Dekalb
Street: 601 Sheppard rd
City: Stone mountain
State: GA

Zip

30083-

Home

(404) 597-1414

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Doubling Up

Education Level

Preschool

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