PAN-CIR-62

Code
PAN-CIR-62
Mercy ID
V-00960-02
Encounter Date
06/25/2002
Last
Pantoja
First
Cirilo
DOB
10/22/1962
County
Fulton
Street
5735 Roswell Rd. Apt.635
City
Roswell
State
GA
Zip
00000-0000
Home
(404) 236-0902
Family Status
Single parent w/children
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
Preschool

Spouse Information

Last
Peña
First
Ignacia
DOB
N/A
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
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
Amalia Pantoja N/A Parents GA/USA
Gilberto Pantoja N/A Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
R. Miranda
Data Entry
K. Aleman
Referred By