Pancho - HER-JUA-48

Code: HER-JUA-48
Mercy ID: B-00004-02
Encounter Date: 07/10/1998
Last: Hernandez
First: Juan
DOB: 08/19/1948
County: Cobb
Street: 564 Little St. Apt. 7
City: Marietta
State: GA

Zip

30008-

Home

(770) 428-9609

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Other

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