MAR-PAS-66

Code
MAR-PAS-66
Mercy ID
V-00675-01
Encounter Date
09/11/2001
Last
Martinez
First
Pascuala
DOB
05/17/1966
County
Dekalb
Street
567 Rimrock Trail
City
Stone mountain
State
GA
Zip
30084-
Home
(404) 593-6410
Cell
(770) 216-9473
Family Status
Single parent w/children
COB
El Salvador
Gender
Female
Housing
Not Homeless
Education Level
some high school

Spouse Information

Last
Loredo
First
Mario
DOB
01/21/1968
Address
2230 Plaster Rd. NE Apt. G
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
YES
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
Alexis Elias 05/17/1988 Mother GA/USA
Franklin Elias 04/24/1994 DFACS GA/USA
Jovany Elias 09/25/1995 DFACS GA/USA
Marcos Elias 06/09/1990 Mother GA/USA
Sandra Elias 10/21/1989 DFACS 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
Rafael/Evaluaciones