Pancho - HER-MAR-76

Code: HER-MAR-76
Mercy ID: V-01022-01
Encounter Date: 10/21/2002
Last: Hernandez
First: Marisol
DOB: 05/15/1976
County: Not given
Street: 1717 Wood Creek
City: Roswell
State: GA

Zip

30076-

Home

(770) 640-9930

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

Vocational/Technical

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