ALB-IRM-78

Code
ALB-IRM-78
Mercy ID
V-00857-01
Encounter Date
03/08/2002
Last
Alberto
First
Irma
DOB
12/23/1978
County
Gwinnett
Street
2306 Noble Forest Drive
City
Norcross
State
GA
Zip
30092-
Home
(770) 449-6298
Cell
(404) 399-1526
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade school

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
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
YES
Consentimiento De Participar
YES

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
Brandon Guerrero 06/09/2000 Mother GA/USA
Samanta Guerrero 09/26/2001 Mother GA/USA

Former Spouse 1 Information

Last
Guerrero
First
Vicente
DOB
06/13/1976
Telephone
N/A
COB
N/A
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
YES
Limitado CL
No
Intake
J. Perez
Data Entry
K. Aleman
Referred By
x7764 Ma. Eugenia