Pancho - JAV-ANT-61

Code: JAV-ANT-61
Mercy ID: V-00339-02
Encounter Date: 11/14/2000
Last: Javalera
First: Antonio
DOB: 06/12/1961
County: Fulton
Street: 1295 robert rd apt b
City: Atlant
State: GA

Zip

30315-

Home

(404) 622-8614

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Doubling Up

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: S. Aviña