MEN-CLE-81

Code
MEN-CLE-81
Mercy ID
V-00540-01
Encounter Date
06/11/2001
Last
Mendez
First
Clemencia
DOB
02/02/1981
County
Cherokee
Street
12 Hillst Circle St.
City
Canton
State
GA
Zip
30114-
Home
(770) 704-7771
Family Status
Two parent family w/children
COB
Guatemala
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Puac
First
Gabino
DOB
N/A
Address
N/A
Telephone
N/A
COB
Guatemala
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
No
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
Candice Puac 01/22/2001 DFACS GA/USA
Clinton Puac N/A Grandmother Guatemala
NOTES

Media Authoritation

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