Pancho - MAL-DIO-78

Code: MAL-DIO-78
Mercy ID: V-02115-02
Encounter Date: 12/20/2005
Last: Maldonado
First: Dionicio
DOB: 10/21/1978
County: Dekalb
Street: 2986 Dresden Dr
City: Chamblee
State: GA

Zip

30341-

Cell

(678) 549-2605

Family Status

Two parent family w/children

COB

Honduras

Gender

Male

Housing

Other

Education Level

Grade 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: F. Perez
Data Entry: R. Gonzalez