Pancho - LOP-JAD-08

Code: LOP-JAD-08
Mercy ID: V-03099-11
Encounter Date: 07/01/2009
Last: Lopez
First: Jade
DOB: 11/24/2008
County: Cobb
Street: 102 Cobb Crossing
City: Smyrna
State: GA

Zip

30080-

Cell

(678) 887-8852

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Yenny Rivadoneir	01/27/1969	Colombia
Father	Luis Lopez	N/A	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
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: C. Martinez
Data Entry: J. Manzo