Pancho - ORT-MEN-77

Code: ORT-MEN-77
Mercy ID: V-02277-11
Encounter Date: 07/12/2006
Last: Escamilla
First: Samantha
DOB: 11/17/2004
County: Gwinnett
Street: 1120 Forrest Valley Ln. Apt. X-4
City: Norcross
State: GA

Zip

30093-

Home

(770) 935-5227

Family Status

Attached youth

COB

USA

Gender

Female Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Ortencia Mendez	01/11/1977	Mexico
Father	Simon Escamilla	01/29/1977	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
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: J. Manzo