Pancho - HER-MRI-68

Code: HER-MRI-68
Mercy ID: V-02552-01
Encounter Date: 07/25/2007
Last: Hernandez
First: Maria del carmen
DOB: 09/16/1968
County: Hall
Street: 461 Northside Apt. A
City: Gainsville
State: GA

Zip

30501-

Home

(770) 536-8496

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

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
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