Pancho - HER-ANA-80

Code: HER-ANA-80
Mercy ID: V-03326-01
Encounter Date: 05/14/2010
Last: Hernandez
First: Ana lilia
DOB: 01/18/1980
County: Gwinnett
Street: 1025 Mercury Dr.
City: Larenceville
State: GA

Zip

30045-

Cell

(770) 709-2682

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

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: YES
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