CAR-GEN-64

Code
CAR-GEN-64
Mercy ID
V-01026-01
Encounter Date
11/13/2002
Last
Carmona
First
Genoveva
DOB
12/25/1964
County
Gwinnett
Street
4083 Sugar Mill Dr.
City
Duluth
State
GA
Zip
30096-
Home
(678) 468-0925
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
De la mora
First
Juan
DOB
02/14/1961
Address
5121 Station Cr. Norcross
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
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
YES
Stranger
YES

Children

NAME DOB LIVING WITH STATE/COUNTRY
Emily 03/08/1995 Mother GA/USA
Susana 09/15/1987 Mother 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
K. Aleman
Referred By
x7764 Ma. Eugenia