HER-SAN-77

Code
HER-SAN-77
Mercy ID
V-01433-01
Encounter Date
12/01/2003
Last
Hernandez
First
Sandra
DOB
01/24/1977
County
Dekalb
Street
6164 Susan Lane
City
Doraville
State
GA
Zip
30340-
Home
(770) 248-9091
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Becerra
First
Alvaro
DOB
N/A
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
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
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Andres Barcenas 03/21/1995 Father GA/USA
Diego Barcenas 05/03/1996 Father GA/USA
Paola Becerra 08/18/2003 Parents GA/USA

Former Spouse 1 Information

Last
Barcenas
First
Jose luis
DOB
N/A
Telephone
N/A
COB
N/A
Home Owner
No
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