Pancho - HER-MAR-95

Code: HER-MAR-95
Mercy ID: V-01721-12
Encounter Date: 11/03/2004
Last: Hernandez
First: Maritza
DOB: 02/17/1995
County: Cobb
Street: 648 Armstrong St. Apt B
City: Marietta
State: GA

Zip

30060-

Home

(678) 355-5365

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Not Homeless

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Isabel Hernandez	08/14/1974	Mexico
Father	Jorge Hernandez	04/23/1971	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Park St. Elementary
Grade: 4th.
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