Pancho - LOP-DEN-66

Code: LOP-DEN-66
Mercy ID: V-01155-01
Encounter Date: 03/11/2003
Last: Lopez
First: Denia
DOB: 03/23/1966
County: Cowetta
Street: 9-A Pope Street Apt. 9A
City: Newman
State: GA

Zip

30263-1823

Home

(678) 423-4052

Family Status

Two parent family w/children

COB

Honduras

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. Perez
Data Entry: K. Aleman