Pancho - GUE-SAM-01

Code: GUE-SAM-01
Mercy ID: V-00857-11
Encounter Date: 05/20/2009
Last: Guerrero
First: Samantha
DOB: 09/26/2001
County: Gwinnett
Street: 2306 Noble Forest Dr.
City: Norcross
State: GA

Zip

30092-

Home

(770) 449-6298

Cell

(404) 399-1526

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Irma Alberto	12/23/1978	Mexico
Father	Vicente Guerrero	06/13/1976	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Peachtree Ind. Elem.
Grade: 2nd.
Who Can't Pickup the Child
Authoritation Parent: YES
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: YES
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: C. Martinez
Data Entry: J. Manzo