Pancho - SUA-BEN-69

Code: SUA-BEN-69
Mercy ID: V-00200-02
Encounter Date: 08/28/2002
Last: Suarez
First: Benjamin
DOB: 04/01/1969
County: Cobb
Street: 6780 Mableton Pwy Lot 49
City: Mableton
State: GA

Zip

30126-

Home

(770) 745-3490

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Not Homeless

Education Level

High school graduate

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: K. Aleman