Pancho - HER-CLA-90

Code: HER-CLA-90
Mercy ID: A-00005-01
Encounter Date: 12/15/2010
Last: Herrera
First: Claudia
DOB: 11/11/1991
County: Fulton
Street: 145 Northwood Dr. # 3
City: Sandy springs
State: GA

Zip

30342-

Cell

(404) 343-9366

Family Status

Single adult

COB

USA

Gender

Female

Housing

Single Family

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