Pancho - HER-ANT-94

Code: HER-ANT-94
Mercy ID: V-01835-21
Encounter Date: 04/07/2005
Last: Hernandez
First: Antonio
DOB: 02/23/1994
County: Gwinnett
Street: 400 Stone Hill Dr.
City: Stone mountain
State: GA

Zip

00000-0000

Home

(678) 789-2280

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Not Homeless

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Griselda Favela	09/19/1973	Mexico
Father	Juan Hernandez	N/A	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
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: K. Aleman
Data Entry: K. Aleman