HER-ROS-70

Code
HER-ROS-70
Mercy ID
V-02676-01
Encounter Date
12/20/2007
Last
Hernandez
First
Rosalia
DOB
10/18/1970
County
Clayton
Street
4324 Shady Lane Way
City
Forest park
State
GA
Zip
30297-
Cell
(678) 558-5859
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade school
Home Owner
YES

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
NOTES
Lives With
N/A
Name of School
N/A
Grade
N/A
Who Can't Pickup the Child

Media

DOY PERMISO
Authoritation Parent
No
Authoritation Child
No
DOY PERMISO
No
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
G. Landeros
Data Entry
J. Manzo