Pancho - LOP-JEN-00

Code: LOP-JEN-00
Mercy ID: V-00813-11
Encounter Date: 01/30/2002
Last: Lopez
First: Jendy
DOB: 09/14/2000
County: Gwinnett
Street: 2010 Harrison Ridge
City: Lawrenceville
State: GA

Zip

30044-

Home

(770) 338-9630

Family Status

Attached youth

COB

USA

Gender

Female Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Gertrudy López	08/25/1971	Dominican Rep
Father	Anthony López	12/18/1973	Dominican Rep
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