Pancho - CAR-JAV-77

Code: CAR-JAV-77
Mercy ID: V-02558-02
Encounter Date: 09/18/2007
Last: Carmona
First: Javier
DOB: 04/30/1977
County: Fulton
Street: 1016 Hampton Ridge
City: Norcross
State: GA

Zip

30093-

Cell

(678) 683-1479

Family Status

Adult couple-no 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: J. Manzo
Data Entry: J. Manzo