Pancho - SAL-HER-57

Code: SAL-HER-57
Mercy ID: V-01077-01
Encounter Date: 01/10/2003
Last: Salcido
First: Hermila
DOB: 07/17/1957
County: Dekalb
Street: 3936 Pleasant Dr.
City: Doraville
State: GA

Zip

30340-

Home

(770) 455-9634

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

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