Pancho - HER-DOR-67

Code: HER-DOR-67
Mercy ID: V-00358-01
Encounter Date: 12/05/2000
Last: Hernandez
First: Dora
DOB: 09/24/1967
County: Dekalb
Street: 6688 Peachtree Industrial
City: Doraville
State: GA

Zip

30360-

Home

(770) 416-9826

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Other

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
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: D. Gomez