DIA-FLO-67

Code
DIA-FLO-67
Mercy ID
V-01411-01
Encounter Date
11/11/2003
Last
Diaz
First
Flor
DOB
04/01/1967
County
Gwinnett
Street
1454 Sydney Pond Cr.
City
Lawrenceville
State
GA
Zip
30045-
Home
(678) 407-2704
Cell
(678) 860-1111
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Some College

Spouse Information

Last
Meraz
First
Jesus
DOB
07/24/1966
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
YES
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
Carlos Hernandez 12/02/1989 Mother GA/USA
Carolina Hfarnandez 10/18/1993 Mother GA/USA
Jessie Meraz 10/31/1996 Mother GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
K. Aleman
Referred By
x3737 Damaryz