Pancho - LOP-REY-70

Code: LOP-REY-70
Mercy ID: V-01052-01
Encounter Date: 12/11/2002
Last: Lopez
First: Reyna
DOB: 01/06/1970
County: Gwinnett
Street: 135 Pine Valley Lane
City: Lawrenceville
State: GA

Zip

30045-

Home

(770) 963-1944

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

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: 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. Manzo
Data Entry: K. Aleman