Pancho - HER-MIR-72

Code: HER-MIR-72
Mercy ID: V-00610-01
Encounter Date: 07/18/2001
Last: Hernandez
First: Miriram
DOB: 10/08/1972
County: Dekalb
Street: P.O. Box 1327
City: Decatur
State: GA

Zip

30031-

Home

(404) 298-7258

Family Status

Single parent w/children

COB

El Salvador

Gender

Female

Housing

Shelter

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