Pancho - PUA-HEC-04

Code: PUA-HEC-04
Mercy ID: V-02088-22
Encounter Date: 11/16/2005
Last: Puac
First: Hector
DOB: 09/27/2004
County: Gwinnett
Street: 515 Wyndham Place Circle
City: Lawrenceville
State: GA

Zip

30044-

Home

(770) 717-8154

Cell

(404) 663-6626

Family Status

Attached youth

COB

USA

Gender

Male Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Sonia Diaz	05/09/1973	Guatemala
Father	Hector Cesar Puac	02/28/1968	Guatemala
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: Volunteer
Data Entry: R. Gonzalez