Pancho - LOP-JER-99

Code: LOP-JER-99
Mercy ID: V-00596-21
Encounter Date: 09/05/2001
Last: Lopez
First: Jerry
DOB: 01/19/1999
County: Gwinnett
Street: 1272 Singleton Cir.
City: Norcross
State: GA

Zip

30093-

Home

(770) 923-8917

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Karla Lopez	11/25/1979	Mexico
Father	Gerardo Pacheco	N/A	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
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: K. Aleman
Data Entry: K. Aleman