Pancho - LOP-ADO-03

Code: LOP-ADO-03
Mercy ID: V-02783-21
Encounter Date: 05/21/2008
Last: Lopez
First: Adolfo
DOB: 03/10/2003
County: Fulton
Street: 2500 Morrosco Plane Apt. E
City: Atlanta
State: GA

Zip

30324-

Cell

(678) 531-5407

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Doubling Up

Education Level

Preschool

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Florencia Carrillo	10/27/1984	Mexico
Father	Lorenzo Lopez	02/19/1978	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Child Dev. Center
Grade: Pre-K
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