Pancho - HER-JOS-65

Code: HER-JOS-65
Mercy ID: V-00218-02
Encounter Date: 05/23/2000
Last: Hernandez
First: Jose t
DOB: 04/01/1965
County: Gwinnett
Street: 1327 Robin Hill Dr.
City: Norcross
State: GA

Zip

30093-

Home

(770) 925-1453

Family Status

Two parent family w/children

COB

El Salvador

Gender

Male

Housing

Doubling Up

Education Level

some high school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	N/A	N/A	N/A
Father	N/A	N/A	N/A
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: N/A
Name of School: N/A
Grade: N/A
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: J. Manzo
Data Entry: D. Gomez