MED-MAR-62

Code
MED-MAR-62
Mercy ID
V-00975-01
Encounter Date
07/22/2002
Last
Medina
First
Maria
DOB
10/07/1962
County
Gwinnett
Street
2630 Millpond CT.
City
Duluth
State
GA
Zip
30096-
Home
(770) 246-6153
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Medina
First
Salvador
DOB
02/02/1958
Address
N/A
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
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
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Alejandra Medina 11/04/1990 Mother GA/USA
Araceli Medina 03/28/1986 Mother GA/USA
Jorge Medina 01/12/1982 Adulto/Casado GA/USA
Salvador Medina 06/08/1996 Mother 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
x7764 Ma. Eugenia