ORT-DOR-54

Code
ORT-DOR-54
Mercy ID
V-01515-01
Encounter Date
03/02/2004
Last
Ortiz
First
Dora
DOB
09/09/1954
County
Dekalb
Street
2824 Pontiac Circle
City
Doraville
State
GA
Zip
30360-
Home
(770) 455-3097
Cell
(678) 642-1232
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Some College

Spouse Information

Last
Ortiz
First
David
DOB
12/09/1963
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
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
David Daniel Ortiz 10/10/1988 Mother GA/USA
Marilin Areas 12/14/1981 Grandmother GA/USA
Roberto Ortiz 09/11/1990 Grandmother 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