Pancho - LOP-GLA-84

Code: LOP-GLA-84
Mercy ID: V-01778-01
Encounter Date: 12/13/2004
Last: Lopez
First: Gladys
DOB: 04/27/1984
County: Cobb
Street: 2050 Austell Rd.
City: Marietta
State: GA

Zip

30008-

Home

(678) 503-0972

Family Status

Adult coupie-no children

COB

Mexico

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: No
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