Pancho - HER-SHI-98

Code: HER-SHI-98
Mercy ID: V-01072-12
Encounter Date: 05/21/2003
Last: Hernandez
First: Shirley
DOB: 11/12/1998
County: Dekalb
Street: 1368 N. Cliff Valley Way G4
City: Atlanta
State: GA

Zip

30319-

Home

(404) 417-9303

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Clara Romero Rayo	09/18/1976	Mexico
Father	Tiburcio Hernandez	08/11/1970	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