ROM-MIR-69

Code
ROM-MIR-69
Mercy ID
V-01080-01
Encounter Date
01/16/2003
Last
Romero
First
Mireya
DOB
04/17/1969
County
Fulton
Street
1906 Ward Circle Apt 1
City
East point
State
GA
Zip
30344-
Home
(404) 763-3863
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Cortez
First
Eduardo
DOB
11/07/1965
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
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
YES
Relative
YES
Stranger
No
As An Adult
YES
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Eduardo Jr. Cortez 12/04/1992 Mother GA/USA
Janet Cortez 08/06/1989 Mother GA/USA
Jose Carlos Cortez 09/08/1987 Mother GA/USA
Martha Leticia Cortez 10/04/1991 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
x3737 Damaryz