Pancho - HER-JOS-70

Code: HER-JOS-70
Mercy ID: V-00065-02
Encounter Date: 02/16/2000
Last: Hernandez
First: Jose luis
DOB: 11/07/1970
County: Fulton
Street: 845 Tahoe BLWF Apt. C
City: Roswell
State: GA

Zip

30076-

Home

(770) 641-1089

Family Status

Two parent family w/children

COB

Mexico

Gender

Male

Housing

Doubling Up

Education Level

some high school

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: R. Miranda
Data Entry: Y. Garcia