LOP-MOI-85

Code
LOP-MOI-85
Mercy ID
V-01910-02
Encounter Date
05/19/2005
Last
Lopez
First
Moises
DOB
03/13/1985
County
Fulton
Street
480 King Arnold Apt D2
City
Atlanta
State
GA
Zip
30354-
Home
(404) 765-4170
Family Status
Two parent family w/children
COB
Mexico
Gender
Male
Education Level
some high 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
NOTES
Lives With
N/A
Name of School
N/A
Grade
N/A
Who Can't Pickup the Child

Media

NO DOY PERMISO
Authoritation Parent
No
Authoritation Child
No
DOY PERMISO
No
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
R. Miranda
Data Entry
K. Aleman