LOP-HER-00

Code
LOP-HER-00
Mercy ID
V-03013-21
Encounter Date
08/11/2010
Last
Lopez
First
Hernan
DOB
12/27/2000
County
Gwinnett
Street
1328 Northwoods lake Court
City
Duluth
State
GA
Zip
30096-
Cell
(678) 598-1546
Family Status
Child/Youth
COB
Colombia
Gender
Male Child
Housing
Single Family
Education Level
Grade school
Home Owner
No

Parents Information

Name DOB COB
Mother Lina Cuadrado 05/03/1970 Colombia
Father Victor Lopez 11/11/1964 Colombia
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Parents
Name of School
Berkely Lake Elem
Grade
4th.
Who Can't Pickup the Child

Media

DOY PERMISO
Authoritation Parent
YES
Authoritation Child
No
DOY PERMISO
No
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
C. Martinez
Data Entry
J. Manzo