CAM-HER-65

Code
CAM-HER-65
Mercy ID
V-00067-02
Encounter Date
01/25/2000
Last
Campos
First
Herberth
DOB
09/10/1965
County
Dekalb
Street
3061 Oakcliff Rd. Apt. 22
City
Doraville
State
GA
Zip
30340-
Home
(770) 457-6994
Family Status
Two parent family w/children
COB
Guatemala
Gender
Male
Housing
Not Homeless
Education Level
High school graduate

Spouse Information

Last
Mancilla
First
Dora
DOB
12/01/1964
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
YES
SOLO
No
Court Mandated
No
Program Completed
YES
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
Gladis 06/17/1994 N/A GA/USA
Omar 07/06/1996 N/A GA/USA
Osmayra 03/06/1989 N/A GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
F. Perez
Data Entry
Y. Garcia
Referred By