LOP-ANA-99

Code
LOP-ANA-99
Mercy ID
V-03474-12
Encounter Date
11/17/2010
Last
Lopez
First
Anayely
DOB
06/09/1999
County
Fulton
Street
125 Nothwood Dr. Apt. 436
City
Roswell
State
GA
Zip
30342-
Cell
(678) 876-6969
Family Status
Child/Youth
COB
USA
Gender
Female Child
Housing
Doubling Up
Education Level
Grade school
Home Owner
YES

Parents Information

Name DOB COB
Mother Edith Dorantes 02/21/1977 Mexico
Father Anibal Lopez 02/12/1973 Mexico
Step Parent Israel Slazar 07/23/1980 Mexico
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Mother w/Stepfather
Name of School
Lakeforest Elem.
Grade
5th.
Who Can't Pickup the Child

Media

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