Pancho - HER-MEL-74

Code: HER-MEL-74
Mercy ID: V-02885-01
Encounter Date: 09/05/2008
Last: Herrera
First: Melisa
DOB: 04/08/1974
County: Gwinnett
Street: 1143 Balvoa Court # D
City: Norcross
State: GA

Zip

30093-

Cell

(678) 598-2624

Family Status

Two parent family w/children

COB

USA

Gender

Female

Housing

Doubling Up

Education Level

High school graduate

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: 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: G. Landeros
Data Entry: J. Manzo