ORT-BLA-70

Code
ORT-BLA-70
Mercy ID
V-00989-01
Encounter Date
08/12/2002
Last
Ortega
First
Blanca
DOB
03/19/1970
County
Cobb
Street
2085 Roswell Rd. Apt. 12
City
Marietta
State
GA
Zip
30062-
Home
(770) 578-9146
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Post Grad Degree

Spouse Information

Last
N/A
First
N/A
DOB
03/19/1970
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
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
Emmil Ortega 05/29/2002 Parents GA/USA
Jessica Garcia Ortega 11/01/2000 Mother w/Stepfather 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