Pancho - PUA-LUI-70

Code: PUA-LUI-70
Mercy ID: V-02251-02
Encounter Date: 06/19/2006
Last: Puac
First: Luis roberto
DOB: 06/21/1970
County: Dekalb
Street: 102 Winter Greek drive
City: Doraville
State: GA

Zip

30360-

Home

(678) 615-3816

Family Status

Two parent family w/children

COB

Guatemala

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: F. Perez
Data Entry: R. Gonzalez