MEN-MAR-79

Code
MEN-MAR-79
Mercy ID
V-00506-01
Encounter Date
09/18/2002
Last
Mendez
First
Maria
DOB
08/02/1979
County
Fulton
Street
1800 Memorial Dr. J-03
City
Atlanta
State
GA
Zip
30317-
Home
(404) 377-8122
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Cortez
First
Enrique
DOB
N/A
Address
N/A
Telephone
N/A
COB
Mexico
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
YES
Consentimiento De Participar
YES

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
Alexis Mendez 04/12/1997 Mother GA/USA
Ansli Mendez 04/02/2000 Mother GA/USA
Jose Cruz 01/11/1996 Mother GA/USA
Karla Mendez 02/20/1999 Mother GA/USA
Violeta Mendez 04/25/2001 Mother GA/USA

Former Spouse 1 Information

Last
Sanchez
First
Nazario
DOB
N/A
Telephone
N/A
COB
N/A
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
K. Aleman
Referred By
Maria Alvarez