PLA-MAR-59

Code
PLA-MAR-59
Mercy ID
V-00034-01
Encounter Date
01/05/2000
Last
Plaza
First
Maria edith
DOB
04/20/1959
County
Gwinnett
Street
990 Eagle Pointe Dr
City
Lawrenceville
State
GA
Zip
30044-
Home
(678) 378-0293
Family Status
Adult coupie-no children
COB
Colombia
Gender
Female
Housing
Not Homeless
Education Level
College Degree

Spouse Information

Last
Moreno
First
Gustavo
DOB
08/25/1957
Address
N/A
Telephone
N/A
COB
Colombia
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
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
Diego Fernando Moreno 11/28/1975 Grandmother 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
D. Gomez
Referred By