Pancho - CIS-SRG-88

Code: CIS-SRG-88
Mercy ID: O-00002-02
Encounter Date: 03/30/2010
Last: Cisneros
First: Sergio
DOB: 09/28/1988
County: Gwinnett
Street: 2000 Noble Forest Dr.
City: Norcross
State: GA

Zip

30092-

Cell

(770) 572-8054

Family Status

Single adult

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: J. Manzo
Data Entry: J. Manzo