Pancho - LOP-ISE-69

Code: LOP-ISE-69
Mercy ID: V-03311-01
Encounter Date: 04/28/2010
Last: Lopez
First: Isela
DOB: 07/19/1969
County: Cobb
Street: 2207cWindcliff Dr.
City: Marietta
State: GA

Zip

30067-

Cell

(404) 207-5529

Family Status

Single adult

COB

Mexico

Gender

Female

Housing

Single Family

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
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: J. Perez
Data Entry: J. Manzo