Pancho - LOP-VIR-65

Code: LOP-VIR-65
Mercy ID: V-01437-01
Encounter Date: 12/08/2003
Last: Lopez
First: Virginia
DOB: 06/04/1965
County: Gwinnett
Street: 3270 Sir Gregory Manor
City: Lawrenceville
State: GA

Zip

30044-

Cell

(678) 848-7978

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Single Family

Education Level

Some College

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: YES
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: G. Landeros
Data Entry: R. Miranda