VAZ-HER-02

Code
VAZ-HER-02
Mercy ID
V-02497-21
Encounter Date
11/03/2010
Last
Vazquez
First
Hernan junior
DOB
08/26/2002
County
Fulton
Street
3815 MLK Jr Dr.
City
Atlanta
State
GA
Zip
30331-
Cell
(678) 882-9463
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Single Family
Education Level
Grade school
Home Owner
No

Parents Information

Name DOB COB
Mother Deodora Mendez 07/02/1977 Guatemala
Father Fabian Vazquez N/A Mexico
Step Parent Jose Perez 06/21/1985 Mexico
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Mother w/Stepfather
Name of School
Catown Elem
Grade
2nd.
Who Can't Pickup the Child

Media

DOY PERMISO
Authoritation Parent
YES
Authoritation Child
No
DOY PERMISO
No
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
Volunteer
Data Entry
J. Manzo