Pancho - HER-OMA-02

Code: HER-OMA-02
Mercy ID: V-01000-23
Encounter Date: 08/28/2002
Last: Hernandez
First: Omar
DOB: 04/17/2002
County: Fulton
Street: 201 Northwood Rd. Apt L2
City: Atlanta
State: GA

Zip

30042-

Home

(404) 459-4241

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Rocio Nava	12/19/1970	Mexico
Father	Adan Hernandez	06/20/1970	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
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: Y. Garcia
Data Entry: K. Aleman