Pancho - BER-CAR-59

Code: BER-CAR-59
Mercy ID: V-00008-01
Encounter Date: 01/10/2000
Last: Beronis
First: Carmen
DOB: 02/05/1959
County: Fulton
Street: 529 huntingtong pl
City: Roswell
State: GA

Zip

30076-

Home

(678) 461-9737

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

High school graduate

Home Owner

No

Parents Information

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

Driver: No
Relative: No
Stranger: No
Lives With: Grandparents
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