HER-MIR-72

Code
HER-MIR-72
Mercy ID
V-00610-01
Encounter Date
07/18/2001
Last
Hernandez
First
Miriram
DOB
10/08/1972
County
Dekalb
Street
P.O. Box 1327
City
Decatur
State
GA
Zip
30031-
Home
(404) 298-7258
Family Status
Single parent w/children
COB
El Salvador
Gender
Female
Housing
Shelter
Education Level
Grade school

Spouse Information

Last
Rebollar
First
Dioselin
DOB
03/24/1982
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
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
Midelvio Contreras 05/23/1998 Mother GA/USA
Odalis Contreras 01/16/1995 Grandmother El Salvador
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 de Shelter