HER-DAN-02

Code
HER-DAN-02
Mercy ID
V-01587-21
Encounter Date
05/19/2004
Last
Hernandez
First
Daniel
DOB
09/03/2002
County
Gwinnett
Street
5305 Muirfield Run
City
Norcross
State
GA
Zip
30093-
Home
(000) 000-0000
Family Status
Attached youth
COB
Mexico
Gender
Male Child
Housing
Doubling Up
Education Level
Child, not in school
Home Owner
YES

Parents Information

Name DOB COB
Mother Sandra Rodriguez 06/26/1980 Mexico
Father Alejandro Hernandez 12/09/1970 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Parents
Name of School
N/A
Grade
N/A
Who Can't Pickup the Child

Media

NO DOY PERMISO
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