LOP-VER-01

Code
LOP-VER-01
Mercy ID
V-03332-01
Encounter Date
05/26/2010
Last
Lopez
First
Veronica
DOB
09/30/1982
County
Fulton
Street
999 NO LA QUISO DAR
City
Atlanta
State
GA
Zip
30315-
Cell
(678) 736-1262
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade school
Home Owner
YES

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