Pancho - HER-ROS-76

Code: HER-ROS-76
Mercy ID: V-02656-01
Encounter Date: 11/26/2007
Last: Hernandez
First: Rosella
DOB: 03/11/1976
County: Forsyth
Street: 110 Park St.
City: Cummings
State: GA

Zip

30040-

Cell

(678) 914-4589

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Single Family

Education Level

College Degree

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