Pancho - HER-MAR-03

Code: HER-MAR-03
Mercy ID: V-01396-01
Encounter Date: 10/29/2003
Last: Hernandez
First: Maria del carmen
DOB: 06/28/1967
County: Clayton
Street: 6225 Tara Blv. Lt. A-35
City: Jonesboro
State: GA

Zip

30236-

Home

(770) 997-7141

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

some high 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