Pancho - HER-AXE-01

Code: HER-AXE-01
Mercy ID: V-03055-21
Encounter Date: 04/22/2009
Last: Hernandez
First: Axel
DOB: 10/12/2001
County: Cobb
Street: 1915 Cardell Rd. L-E 31
City: Austell
State: GA

Zip

30168-

Cell

(678) 949-0657

Family Status

Child/Youth

COB

Mexico

Gender

Male Child

Housing

Single Family

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Cinthia Contreras	04/23/1984	Mexico
Father	Geovani Hernandez	12/16/1980	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Bryant Elem.
Grade: 1st.
Who Can't Pickup the Child
Authoritation Parent: YES
Authoritation Child: No
DOY PERMISO: YES
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: C. Martinez
Data Entry: J. Manzo