PEÑ-MIR-67

Code
PEÑ-MIR-67
Mercy ID
V-00452-01
Encounter Date
03/14/2001
Last
Peña
First
Miriam
DOB
07/27/1967
County
Gwinnett
Street
2800 Herrington Woodet BLd6 Apt-303
City
Lawrenceville
State
GA
Zip
30044-
Home
(678) 376-8784
Family Status
Single adult
COB
Colombia
Gender
Female
Housing
Not Homeless
Education Level
some high school

Spouse Information

Last
Jimenez
First
Mauricio
DOB
05/09/1966
Address
N/A
Telephone
N/A
COB
Colombia
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
No
Program Completed
No
DFCS Mandated
No
Alcohol & Drug
No
Partner Referred to Tepestri
No
Recidivism/Court
No
New Incident
No
Promesa de Confidencialidad
No
Consentimiento De Participar
No

Petitioner

TPO
No
Stay Away Condition
No
Mutual
No

Defendant

TPO
No
Stay Away Condition
No
Mutual
No
Driver
YES
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
andrea vanessa jimenez peña 07/01/1989 N/A mexico
christian camilo jimenez peña 04/28/1986 N/A mexico
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
D. Gomez
Referred By
7764 maria eugenia