Pancho - HER-BRE-83

Code: HER-BRE-83
Mercy ID: V-02980-01
Encounter Date: 01/06/2009
Last: Hernandez
First: Brenda
DOB: 11/13/1983
County: Gwinnett
Street: 999 no la dio
City: No la dio
State: GA

Zip

99999-

Cell

(678) 773-2833

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

Some College

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