A person who knowingly or willfully makes public or discloses to any unauthorized person any confidential

information contained in the central abuse hotline is subject to the penalty provisions of s. 39.205.

INTAKE REPORT

Intake Name Intake Number County Secondary County

Unknown, Unknown 2018-739787-03 Miami-Dade Miami-Dade
Date and Time Intake Received Program Type Investigative Sub-Type Provider Name
01/09/2019 6:05 PM Child Intake - Additional In-Home N/A
Background Checks Required Reason Call Record Number 3 Hits Reviewed
Yes No No New Subjects Yes N/A
Worker Safety Concerns Prior Involvement Law Enforcement Notified
Yes No Yes No Yes No
Send Florida Administrative Message to Law Enforcement Yes N/A
Response Time Name – Worker Name – Supervisor
24 Hours Rodriguez, Marsha PERINON, MILTON
I. Family Information
Name – Family Telephone Number – Home
Unknown, Unknown
Address – Street Unit Designator City State Zip Code
19940 West Dixie Highway Apartment 1301 Miami FL 33180
Primary Language: Interpreter Needed: Yes No
Directions to House
Current/24 hour location:

Foster home-

The foster mother's phone number-

A. Participants
Name ID Number Role Gender DOB
Emmanuel, Samayah Anne V Female 09/02/2011
Est. Age Ethnicity Race Disability
8 African American/Black Black/African Yes No
American
Hearing Impaired: Yes No 24 Access Yes No
Device Needed:
V Female
Est. Age Ethnicity Race Disability
13 Unable To Determine Unable to Determine Yes No
Hearing Impaired: Yes No 24 Access Yes No
Device Needed:
V Female
Est. Age Ethnicity Race Disability
6 African American/Black Black/African Yes No
American
Hearing Impaired: Yes No 24 Access Yes No
Device Needed:
V Male
Est. Age Ethnicity Race Disability
5 African American/Black Black/African Yes No
American
A person who knowingly or willfully makes public or discloses to any unauthorized person any confidential
information contained in the central abuse hotline is subject to the penalty provisions of s. 39.205.

Hearing Impaired: Yes No 24 Access Yes No

Device Needed:
Julmiste, Renette AP-HM Female 07/18/1976
Est. Age Ethnicity Race Disability
43 Unknown Yes No
Hearing Impaired: Yes No 24 Access Yes No
Device Needed:
Emmanuel, Gina AP-HM-IN-PC Female 12/06/1968
Est. Age Ethnicity Race Disability
50 Haitian Black/African Yes No
American
Hearing Impaired: Yes No 24 Access Yes No
Device Needed:

AP = Alleged Perpetrator PC = Parent/Caregiver JS = Alleged Juvenile Sexual Offender

CH = Child In Home IN = Intake Name IC = Identified Child
HM = Household Member SO = Significant Other RN = Referral Name / SC Referral Name
NM = Non-Household Member V = Victim

B. Address and Phone Information

Name Type Address Telephone Number
Emmanuel, Samayah Anne Primary 19940 West Dixie Highway Apartment 1301
Residence Miami, FL 33180
Primary
Residence
Primary
Residence
Primary
Residence
Julmiste, Renette Primary
Residence
Emmanuel, Gina Primary 19940 West Dixie Highway Apartment 1301
Residence Miami, FL 33180

C. Relationships
Subject Relationship Subject
Emmanuel, Gina Mother Emmanuel, Samayah Anne
Emmanuel, Gina Mother
Emmanuel, Gina Mother
Emmanuel, Gina Mother
Emmanuel, Samayah Anne Daughter Emmanuel, Gina
Emmanuel, Samayah Anne Unknown Julmiste, Renette
Daughter Emmanuel, Gina
Daughter Emmanuel, Gina
Son Emmanuel, Gina
Julmiste, Renette Unknown Emmanuel, Samayah Anne
Julmiste, Renette Unknown
Julmiste, Renette Unknown
A person who knowingly or willfully makes public or discloses to any unauthorized person any confidential
information contained in the central abuse hotline is subject to the penalty provisions of s. 39.205.

Julmiste, Renette Unknown

D. Alleged Maltreatment
Alleged Victim Maltreatment Code
Emmanuel, Samayah Anne Burns
Emmanuel, Samayah Anne Substance Misuse

E. Location of Incident
Address – Street Apt. City State Zip Code

Telephone Number – Home Telephone Number – Work Telephone Number - Cell

II. Narratives
A. Allegation Narrative
While in the care of the adoptive mother, the adoptive mother would make stand with her arms up in a
position similar to a crucifixion position and when her arms would begin to hurt and she would lower them, the
adoptive mother would slap her on the bottom of her arms in the triceps area with a shoe. The adoptive mother
put Samayah's hand on the stove and burnt their hands because she took a piece of bread. The mother gave
Samayah bleach to drink.

On 11/3/2018, Samayah passed away from pneumonia but there are concerns for abuse because she had fluid
coming out of her mouth and when she was examined, extensive healed bones and open sores were found.

is blocking a lot of the trauma regarding Samayah's death. She does not talk about Samayah's death.

Samayah was homeschooled and did not have interaction with the outside world.

A. Provider Detail

B. Narrative for Worker Safety Concerns

A person who knowingly or willfully makes public or discloses to any unauthorized person any confidential
information contained in the central abuse hotline is subject to the penalty provisions of s. 39.205.

III. Agency Response

A. Recommendation
System Screening Recommendation Counselor Screening Recommendation Counselor Screening Reason
Pending
Counselor Name Counselor Screening Date/Time

Reason for Override:

System Response Priority Recommendation Counselor Response Priority Recommendation Date/Time Decision Made

Reason for Override:

B. Decision
Decision Date/Time Decision Made Reason
Screen In 01/09/2019 7:30 PM Screen In - Accepted for Services/Investigation
Worker: Rodriguez, Marsha
Explain:

IV. CI Unit Documentation

First Call Attempted Date/Time Completed Call Date/Time

Call Log

Called Out By Called To

Rodriguez, Marsha