HER-EMI-07

Code
HER-EMI-07
Mercy ID
V-03472-22
Encounter Date
11/10/2010
Last
Hernandez
First
Emilio
DOB
06/22/2007
County
Dekalb
Street
2288 La vista Road Apt. 1
City
Atlanta
State
GA
Zip
30329-
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Single Family
Education Level
Child, not in school
Home Owner
YES

Parents Information

Name DOB COB
Mother Valentina Cruz 10/05/1978 Mexico
Father Marbel Hernandez 05/06/1981 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
YES
Authoritation Child
No
DOY PERMISO
YES
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
C. Martinez
Data Entry
J. Manzo