HER-LOR-74

Code
HER-LOR-74
Mercy ID
V-00618-01
Encounter Date
07/27/2001
Last
Hernandez
First
Lorena
DOB
08/13/1974
County
Cobb
Street
1701 Water Fall Village Dr.
City
Marietta
State
GA
Zip
30067-
Home
(770) 319-6456
Family Status
Two parent family w/children
COB
Guatemala
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Palencia
First
Francisco
DOB
09/11/1950
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
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
Elizabeth Palencia 03/15/1998 Parents GA/USA
Lizbeth Palencia 08/11/1999 Parents GA/USA
Melissa Palencia Hernandez 07/02/1996 Parents GA/USA
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
x7764 Rita