HER-NIC-60

Code
HER-NIC-60
Mercy ID
V-00562-01
Encounter Date
05/10/2001
Last
Hernandez
First
Nicolasa
DOB
09/10/1960
County
Fulton
Street
160 McKown Rd.
City
Fayetteville
State
GA
Zip
30214-
Home
(678) 817-6246
Family Status
Single parent 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
NOTES
Lives With
N/A
Name of School
N/A
Grade
N/A
Who Can't Pickup the Child

Media

NO DOY PERMISO
Authoritation Parent
No
Authoritation Child
No
DOY PERMISO
No
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
J. Manzo
Data Entry
K. Aleman