Pancho - RET-SAM-99

Code: RET-SAM-99
Mercy ID: V-01277-11
Encounter Date: 06/20/2007
Last: Retana
First: Samantha
DOB: 10/08/1999
County: Gwinnett
Street: 2074 Ravinia Ct.
City: Lawrenceville
State: GA

Zip

30044-

Cell

(404) 454-7068

Family Status

Attached youth

COB

USA

Gender

Female Child

Housing

Not Homeless

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Norma Garcia	12/29/1968	Mexico
Father	Ivan Retana	10/27/1969	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Ja alford Elem.
Grade: 1st.
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