HER-GUA-78

Code
HER-GUA-78
Mercy ID
V-03267-01
Encounter Date
02/23/2010
Last
Hernandez
First
Guadalupe
DOB
08/04/1978
County
Forsyth
Street
1085 Homesteaders Road # 85
City
Cumming
State
GA
Zip
30041-
Cell
(678) 600-7626
Family Status
Two parent family 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
No
Relative
No
Stranger
No
NOTES
Lives With
N/A
Name of School
N/A
Grade
N/A
Who Can't Pickup the Child

Media

NO 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