MIR-EDI-77

Code
MIR-EDI-77
Mercy ID
V-01043-01
Encounter Date
11/07/2002
Last
Miranda
First
Edith
DOB
04/01/1977
County
Dekalb
Street
2013 Winter Path Dr.
City
Doraville
State
GA
Zip
30360-
Home
(678) 530-9855
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Rubio
First
Miguel
DOB
07/22/1974
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
YES
As A Child
YES
Relative
YES
Stranger
No
As An Adult
YES
Partner
No
Relative
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Jasmin 08/31/1997 Mother GA/USA
Jeanett 10/24/1995 Mother GA/USA
Miguel 08/09/2002 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 Rebecca