Pancho - LOP-JON-02

Code: LOP-JON-02
Mercy ID: V-00475-22
Encounter Date: 02/16/2005
Last: Lopez
First: Jonathan
DOB: 03/21/2002
County: Gwinnett
Street: 4498 Buford Hwy Lot 201
City: Norcross
State: GA

Zip

30071-

Home

(770) 797-9376

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Janet Espinoza	02/12/1979	Mexico
Father	David Lopez	12/05/1978	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
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: Y. Garcia
Data Entry: K. Aleman