Pancho - FER-EMM-64

Code: FER-EMM-64
Mercy ID: V-00750-01
Encounter Date: 11/15/2001
Last: Fernandez
First: Emma
DOB: 12/22/1964
County: Gwinnett
Street: 2065 Ravinia Ct.
City: Lawrenceville
State: GA

Zip

30044-

Home

(770) 448-9101

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Other

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: 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: K. Aleman