Pancho - BEN-HON-78

Code: BEN-HON-78
Mercy ID: V-00525-01
Encounter Date: 10/03/2002
Last: Benitez
First: Honorina
DOB: 11/24/1978
County: Fulton
Street: 6558 Roswell Rd. Apt 1-D
City: Atlanta
State: GA

Zip

30328-

Home

(678) 886-4471

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

Grade school

Home Owner

No

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. Perez
Data Entry: K. Aleman