Pancho - ROJ-ANT-59

Code: ROJ-ANT-59
Mercy ID: V-02100-02
Encounter Date: 01/24/2006
Last: Rojas
First: Antonio
DOB: 05/08/1959
County: Fulton
Street: 4594 Puchett St.
City: Forest park
State: GA

Zip

30297-

Home

(404) 361-2114

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Doubling Up

Education Level

Post Grad 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: R. Miranda
Data Entry: R. Gonzalez