Pancho - LOP-RUT-81

Code: LOP-RUT-81
Mercy ID: V-02109-01
Encounter Date: 10/28/2005
Last: Lopez
First: Ruth jazmin
DOB: 06/02/1981
County: Dekalb
Street: 3526 Pleasant Dale
City: Doraville
State: GA

Zip

30340-

Home

(770) 572-4504

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

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
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