PER-DOL-61

Code
PER-DOL-61
Mercy ID
V-00656-01
Encounter Date
08/24/2001
Last
Perez
First
Dolores
DOB
03/24/1961
County
Gwinnett
Street
725-7 Beaver Ruin Rc.
City
Norcross
State
GA
Zip
30071-
Home
(770) 441-2499
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Quiroz
First
Rogelio
DOB
02/25/1957
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
Javier 08/28/1985 Father GA/USA
Jose Adrian 01/09/1983 Adulto/Soltero GA/USA
Ma. Guadalupe 10/21/1991 Mother GA/USA
Mauricio 01/01/1981 Father GA/USA
Rogelio 04/25/1979 Father GA/USA
Rosa Angel 10/21/1991 Mother GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
K. Aleman
Referred By
X7764 Ma. Eugenia