Pancho - LOP-EDI-70

Code: LOP-EDI-70
Mercy ID: V-02955-01
Encounter Date: 12/02/2008
Last: Lopez
First: Edith
DOB: 12/18/1970
County: Clayton
Street: 522 Buckheadtell Road
City: Jonesboro
State: GA

Zip

30238-

Cell

(404) 453-7808

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: 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: J. Manzo