Pancho - LOP-MAX-97

Code: LOP-MAX-97
Mercy ID: V-01437-22
Encounter Date: 03/17/2010
Last: Lopez
First: Max
DOB: 12/22/1997
County: Gwinnett
Street: 3270 Sir Gregory Manor
City: Larenceville
State: GA

Zip

30044-

Cell

(678) 848-7978

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Single Family

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Virginia Lopez	06/04/1965	Mexico
Father	Ramiro Lopez	08/23/1964	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Sweetwater Mid.
Grade: 7th.
Who Can't Pickup the Child
Authoritation Parent: YES
Authoritation Child: No
DOY PERMISO: YES
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: C. Martinez
Data Entry: J. Manzo