Pancho - MON-SAM-00

Code: MON-SAM-00
Mercy ID: V-01482-13
Encounter Date: 11/02/2005
Last: Mondragon
First: Samantha
DOB: 11/16/2000
County: Gwinnett
Street: 3221 Fescue Circle
City: Lawrenceville
State: GA

Zip

30044-

Cell

(404) 394-8028

Family Status

Attached youth

COB

USA

Gender

Female Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Maria Paulina Vega	02/01/1967	Mexico
Father	Oscar Mondragon	10/22/1971	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
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: Volunteer
Data Entry: R. Gonzalez