BEN-HER-80

Code
BEN-HER-80
Mercy ID
V-03396-01
Encounter Date
09/15/2010
Last
Benitez
First
Hermenegilda
DOB
09/30/1980
County
Dekalb
Street
1512 Drook Court
City
Doraville
State
GA
Zip
30340-
Cell
(770) 256-2512
Family Status
Single parent 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
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

DOY PERMISO
Authoritation Parent
No
Authoritation Child
No
DOY PERMISO
YES
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
G. Landeros
Data Entry
J. Manzo