Pancho - LOP-CLA-76

Code: LOP-CLA-76
Mercy ID: V-02040-01
Encounter Date: 09/19/2005
Last: Lopez
First: Claudia
DOB: 03/16/1976
County: Gwinnett
Street: 3410 Talisade Lake Dr.
City: Duluth
State: GA

Zip

30096-

Home

(770) 495-5090

Family Status

Single parent w/children

COB

El Salvador

Gender

Female

Housing

Doubling Up

Education Level

Grade school

Home Owner

YES

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: YES
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: G. Landeros
Data Entry: R. Gonzalez