Pancho - HER-JOS-93

Code: HER-JOS-93
Mercy ID: V-02676-21
Encounter Date: 01/02/2008
Last: Hernandez
First: Jose
DOB: 01/21/1993
County: Clayton
Street: 4324 Shady Way
City: Forest park
State: GA

Zip

30297-

Cell

(678) 558-5859

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Single Family

Education Level

some high school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Rosalia Hernandez	10/18/1970	Mexico
Father	Juan Hernandez	01/31/1969	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Forest Park HS
Grade: 9th.
Who Can't Pickup the Child
Authoritation Parent: YES
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: C. Martinez
Data Entry: J. Manzo