Pancho - ARE-SAM-02

Code: ARE-SAM-02
Mercy ID: V-01233-11
Encounter Date: 12/05/2007
Last: Arellano
First: Samantha
DOB: 09/14/2002
County: Gwinnett
Street: 3450 Breckingridge Blvd. # 502
City: Duluth
State: GA

Zip

30096-

Cell

(404) 447-2632

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Preschool

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Claudia Padilla	08/23/1973	Mexico
Father	Jorge Luis Arellano	11/24/1969	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Learning Center American
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: C. Martinez
Data Entry: J. Manzo