Pancho - HER-IVA-99

Code: HER-IVA-99
Mercy ID: V-00037-21
Encounter Date: 02/16/2000
Last: Hernandez
First: Ivan
DOB: 03/30/1999
County: Dekalb
Street: 3629 admiral dr
City: Chamblee
State: GA

Zip

30341-

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	benita tapia	02/12/1969	Mexico
Father	alfredo hernandez	02/22/1969	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
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: S. Aviña