Pancho - ROM-HIP-02

Code: ROM-HIP-02
Mercy ID: V-02524-22
Encounter Date: 08/01/2007
Last: Romero
First: Hipolito
DOB: 09/02/2002
County: Gwinnett
Street: 2178 Rockdale Circle
City: Snellville
State: GA

Zip

30078-

Cell

(678) 725-0809

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Single Family

Education Level

Preschool

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Elizabeth Arreola	11/28/1970	Mexico
Father	Hipolito Romero	05/10/1969	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Pre-school
Grade: Pre-K
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: C. Martinez
Data Entry: J. Manzo