DEL-MIC-73

Code
DEL-MIC-73
Mercy ID
V-01062-01
Encounter Date
12/24/2002
Last
Delao
First
Miceli
DOB
01/16/1973
County
Gwinnett
Street
999 no sabe
City
Norcross
State
GA
Zip
99999-
Home
(404) 276-4065
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Transitional
Education Level
High school graduate

Spouse Information

Last
Mondragon
First
Abel
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
David N/A Mother GA/USA
Imelda N/A Mother GA/USA
Isabel N/A 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
J. Manzo
Referred By
x7764 Rebeca