MAR-SOC-65

Code
MAR-SOC-65
Mercy ID
V-01147-01
Encounter Date
03/13/2003
Last
Martinez
First
Socorro
DOB
05/09/1965
County
Gwinnett
Street
3336 Duncan Bridge
City
Bufford
State
GA
Zip
30519-
Home
(770) 271-2226
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Martinez
First
Isidoro
DOB
04/04/1966
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
YES
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
YES
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Agustin 10/27/1996 Parents GA/USA
Cassandra Martinez N/A Father w/Stepmother GA/USA
Daniel 01/09/2001 Parents GA/USA
Jenny 10/02/1992 Parents GA/USA
Jonathan 01/17/1996 Parents 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
Fr. Hernand 770-448-2028 ex17