Pancho - LOP-JOV-03

Code: LOP-JOV-03
Mercy ID: V-01532-21
Encounter Date: 04/07/2004
Last: Lopez
First: Jovani
DOB: 04/19/2003
County: Fulton
Street: 745 Morosco Dr. Apt 6
City: Atlanta
State: GA

Zip

30324-

Home

(404) 846-6541

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Floriberta (Flor) Morales	06/17/1981	Mexico
Father	Victor Lopez	09/15/1982	Mexico
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