Pancho - HER-ADE-84

Code: HER-ADE-84
Mercy ID: V-02465-01
Encounter Date: 04/11/2007
Last: Hernandez
First: Adela
DOB: 09/08/1984
County: Wayne
Street: not given
City: Jesut
State: GA

Zip

99999-

Home

(912) 588-9999

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Shelter

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: J. Manzo