Pancho - GOM-ROD-76

Code: GOM-ROD-76
Mercy ID: V-00319-02
Encounter Date: 10/24/2000
Last: Gomez
First: Rodolfo
DOB: 03/22/1976
County: Dekalb
Street: 1392 North Cliff Valley Apt D
City: Atlanta
State: GA

Zip

30319-

Home

(404) 636-1376

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Doubling Up

Education Level

Preschool

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: R. Miranda
Data Entry: K. Aleman