Pancho - HER-DIE-02

Code: HER-DIE-02
Mercy ID: V-02369-21
Encounter Date: 12/20/2006
Last: Hermandez
First: Diego
DOB: 11/05/2002
County: Clayton
Street: not given
City: Jonesboro
State: GA

Zip

99999-9999

Home

(404) 438-4796

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Luvia Boyzo	12/28/1980	Mexico
Father	N/A	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: Volunteer
Data Entry: J. Manzo