Pancho - HER-EDN-97

Code: HER-EDN-97
Mercy ID: V-01587-11
Encounter Date: 05/19/2004
Last: Hernandez
First: Edna
DOB: 11/10/1997
County: Gwinnett
Street: 5305 Muirfield Run
City: Norcross
State: GA

Zip

30093-

Home

(000) 000-0000

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Doubling Up

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Sandra Rodriguez	06/26/1980	Mexico
Father	Alejandro Hernandez	02/09/1970	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: N/A
Name of School: N/A
Grade: Kinder
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