Pancho - LOP-ROS-76

Code: LOP-ROS-76
Mercy ID: V-00356-01
Encounter Date: 11/30/2000
Last: Lopez
First: Rosa
DOB: 01/23/1976
County: Fulton
Street: 5320 Roswell Rd. I-3
City: Atlanta
State: GA

Zip

30342-

Home

(404) 303-7149

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

some high 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. Manzo
Data Entry: K. Aleman