LOP-JON-97

Code
LOP-JON-97
Mercy ID
V-03474-22
Encounter Date
11/17/2010
Last
Lopez
First
Jonathan
DOB
06/04/1997
County
Fulton
Street
125 Northwood Dr. Apt. 436
City
Roswell
State
GA
Zip
30342-
Cell
(678) 876-6969
Family Status
Child/Youth
COB
USA
Gender
Male 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 Salazar 07/23/1980 Mexico
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Mother w/Stepfather
Name of School
Richview Middle
Grade
7th.
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