CIS-MAR-65

Code
CIS-MAR-65
Mercy ID
V-00587-01
Encounter Date
07/11/2001
Last
Cisneros
First
Maria
DOB
02/07/1965
County
Gwinnett
Street
1355 Graves Road Apt. o-4
City
Norcross
State
GA
Zip
30093-
Cell
(678) 789-5611
Family Status
Single parent w/children
COB
El Salvador
Gender
Female
Housing
Single Family
Education Level
Vocational/Technical

Spouse Information

Last
Garcia
First
Regino
Middle
H.
DOB
06/29/1975
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
YES
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
Angel Cisneros 08/09/2005 Mother GA/USA
Emmanuel J. Cisneros 06/13/2007 Mother GA/USA
Rogelio Cisneros 12/10/1999 Mother GA/USA
Vanessa Fuentes 05/02/1997 Mother GA/USA

Former Spouse 1 Information

Last
Fuentes
First
Hector
DOB
N/A
Telephone
N/A
COB
El Salvador
Home Owner
No
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
amiga