Pancho - HER-REG-74

Code: HER-REG-74
Mercy ID: V-02048-01
Encounter Date: 10/04/2005
Last: Hernandez
First: Regina
DOB: 05/31/1974
County: Gwinnett
Street: 1809 Parkcross
City: Lilburn
State: GA

Zip

30047-

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

Preschool

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
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: G. Landeros
Data Entry: R. Gonzalez