Pancho - MOL-SAM-00

Code: MOL-SAM-00
Mercy ID: V-01897-12
Encounter Date: 05/18/2005
Last: Molina
First: Samantha
DOB: 01/28/2000
County: Fulton
Street: 3144 Martin Luther King Jr. Rd. D6
City: Atlanta
State: GA

Zip

30311-

Home

(404) 696-5267

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Doubling Up

Education Level

Preschool

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	mirely Mena	07/26/1972	Honduras
Father	Degniy Molina	N/A	Honduras
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: N/A
Name of School: N/A
Grade: Pre-K
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: Y. Garcia
Data Entry: K. Aleman