Pancho - HER-RAU-05

Code: HER-RAU-05
Mercy ID: V-03220-21
Encounter Date: 12/02/2009
Last: Hernandez
First: Raul
DOB: 05/05/2005
County: Gwinnett
Street: 3240 Sunrise Lane Apt. C
City: Norcross
State: GA

Zip

30093-

Cell

(404) 259-4649

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Single Family

Education Level

Preschool

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Ana Platero	04/09/1979	Mexico
Father	Raul Hernandez	07/16/1978	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Sky Heaven
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