Pancho - KHA-SAM-07

Code: KHA-SAM-07
Mercy ID: V-02438-11
Encounter Date: 09/17/2007
Last: Khanimov
First: Samantha
DOB: 04/24/2007
County: Fulton
Street: 5501 Glenridge Dr. Apt. 905
City: Atlanta
State: GA

Zip

30342-

Cell

(404) 309-5419

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Preschool

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Rosaura Galan	09/03/1973	Perú
Father	Abo Khanimov	02/17/1969	Rusia
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Chayamushka Pre-school
Grade: Daycare
Who Can't Pickup the Child: Abo Khanimov
Authoritation Parent: YES
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: YES
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: J. Perez
Data Entry: J. Manzo