HER-VIR-04

Code
HER-VIR-04
Mercy ID
V-03152-11
Encounter Date
09/09/2009
Last
Hernandez
First
Viridiana
DOB
10/18/2004
County
Gwinnett
Street
4361 E. Meadow Dr.
City
Duluth
State
GA
Zip
30096-
Home
(770) 676-0757
Family Status
Child/Youth
COB
USA
Gender
Female Child
Housing
Single Family
Education Level
Child, not in school
Home Owner
YES

Parents Information

Name DOB COB
Mother Gabriela Quezada 07/29/1967 Mexico
Father Luis Hernandez 09/12/1967 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Parents
Name of School
N/A
Grade
N/A
Who Can't Pickup the Child

Media

NO DOY PERMISO
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