Pancho - SAN-HER-69

Code: SAN-HER-69
Mercy ID: V-02910-01
Encounter Date: 10/13/2008
Last: Sanchez
First: Hermelinda
DOB: 10/28/1969
County: Gwinnett
Street: 4155 Satelite Boulevard #414
City: Duluth
State: GA

Zip

30096-

Cell

(404) 645-9562

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Single Family

Education Level

Grade 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: G. Landeros
Data Entry: J. Manzo