FON-HER-59

Code
FON-HER-59
Mercy ID
V-01407-01
Encounter Date
11/04/2003
Last
Fonseca
First
Herminia
DOB
06/22/1959
County
Hall
Street
P.O. Box 2962
City
Gainsville
State
GA
Zip
30501-
Home
(678) 521-7688
Family Status
Single parent w/children
COB
Puerto Rico
Gender
Female
Housing
Transitional
Education Level
Some College

Spouse Information

Last
Coyra
First
Jorge
DOB
10/30/1960
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
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
YES
Relative
YES
Stranger
No
As An Adult
YES
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Genesis Coyra 09/01/2000 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