Pancho - HER-FID-64

Code: HER-FID-64
Mercy ID: V-01852-02
Encounter Date: 03/22/2005
Last: Hernandez
First: Fidel
DOB: 03/23/1964
County: Dekalb
Street: 1327 N. Cliff Valley HC
City: Atlanta
State: GA

Zip

30319-

Home

(706) 372-3856

Family Status

Single adult

COB

Mexico

Gender

Male

Housing

Doubling Up

Education Level

High school graduate

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: K. Aleman