HER-MAR-67

Code
HER-MAR-67
Mercy ID
V-00632-01
Encounter Date
05/28/2002
Last
Hernandez
First
Marta
DOB
05/21/1967
County
Cobb
Street
120 Johston Pkway
City
Kennessaw
State
GA
Zip
30152-
Home
(770) 422-5227
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Vasquez
First
Alejandro
DOB
03/13/1969
Address
707 Franklin Rd. Apt. 1402 Marietta GA 30067
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
Alexander Vasquez 04/07/1999 Parents GA/USA
Lesly Vazquez 09/21/2000 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 Ma. Eugenia