Pancho - LOP-JAC-02

Code: LOP-JAC-02
Mercy ID: V-02776-11
Encounter Date: 05/07/2008
Last: Lopez
First: Jacquelin
DOB: 05/18/2002
County: Gwinnett
Street: 2004 Marsh Creek Drive
City: Lawrenceville
State: GA

Zip

30043-

Cell

(678) 499-9192

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Doubling Up

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Maria Gomez	08/16/1980	Mexico
Father	Pablo Lopez	03/06/1978	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Walnut Grove Elem.
Grade: Kinder
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: C. Martinez
Data Entry: J. Manzo