Pancho - COR-JOS-71

Code: COR-JOS-71
Mercy ID: V-00210-02
Encounter Date: 05/16/2000
Last: Coronado
First: Jose
DOB: 08/20/1971
County: Cobb
Street: 1034 Frankling Rd Apr J-6
City: Marietta
State: GA

Zip

30067-

Home

(678) 618-3456

Family Status

Adult coupie-no children

COB

Mexico

Gender

Male

Housing

Doubling Up

Education Level

some high 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: D. Gomez