LOP-MAT-72

Code
LOP-MAT-72
Mercy ID
V-02882-01
Encounter Date
08/15/2008
Last
Lopez
First
Martha
DOB
03/21/1972
County
Dekalb
Street
5601 Chamblee Tucker Road A-18
City
Chamblee
State
GA
Zip
30340-
Cell
(678) 552-2224
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade 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
G. Landeros
Data Entry
J. Manzo