Pancho - HER-REY-64

Code: HER-REY-64
Mercy ID: V-01585-01
Encounter Date: 05/05/2004
Last: Hernandez
First: Reyna
DOB: 07/15/1966
County: Gwinnett
Street: 235 Mountain Dr.
City: Stone mountain
State: GA

Zip

30087-

Home

(770) 498-2014

Cell

(678) 849-7053

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Single Family

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: YES
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: J. Perez
Data Entry: K. Aleman