Pancho - LOP-KEV-00

Code: LOP-KEV-00
Mercy ID: V-01569-21
Encounter Date: 04/21/2004
Last: Lopez
First: Kevin
DOB: 12/13/2000
County: Gwinnett
Street: 1201 Park Colony Dr.
City: Norcross
State: GA

Zip

30093-

Home

(770) 908-9162

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Martha Rodriguez	12/22/1976	Mexico
Father	Jose Manuel Lopez	05/19/1974	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: Volunteer
Data Entry: K. Aleman