HER-ISA-61

Code
HER-ISA-61
Mercy ID
V-01525-01
Encounter Date
03/12/2004
Last
Hernandez
First
Isalia
DOB
10/27/1961
County
Gwinnett
Street
838 Northwood Lake
City
Duluth
State
GA
Zip
30071-
Home
(000) 000-0000
Cell
(678) 410-1956
Family Status
Single adult
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
YES
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