Pancho - ESP-OCT-72

Code: ESP-OCT-72
Mercy ID: V-00121-02
Encounter Date: 02/21/2000
Last: Espinoza
First: Octavio
DOB: 07/18/1972
County: Other
Street: 2390 Fairburn Rd.
City: Douglasville
State: GA

Zip

30135-

Home

(678) 838-9394

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Not Homeless

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: R. Miranda
Data Entry: Y. Garcia