Pancho - NAV-FER-69

Code: NAV-FER-69
Mercy ID: V-00130-02
Encounter Date: 02/22/2000
Last: Navarrete
First: Fermin
DOB: 07/07/1969
County: Fulton
Street: 1676 briafcliff rd apt27
City: Atlanta
State: GA

Zip

30306-

Home

(404) 817-0676

Family Status

Single parent w/children

COB

Mexico

Gender

Male

Housing

Doubling Up

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: S. Aviña