CAR-EDI-70

Code
CAR-EDI-70
Mercy ID
V-01707-01
Encounter Date
09/20/2004
Last
Carillo
First
Edith
DOB
03/13/1970
County
Gwinnett
Street
3309 Dunleaf Arc Way NE
City
Norcross
State
GA
Zip
30093-
Home
(770) 717-9995
Family Status
Two parent family w/children
COB
Colombia
Gender
Female
Housing
Not Homeless
Education Level
Some College

Spouse Information

Last
Morales
First
Edgar
DOB
05/19/1979
Address
N/A
Telephone
N/A
COB
Colombia
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
YES

Children

NAME DOB LIVING WITH STATE/COUNTRY
Juan Sebastian Morales 03/19/2000 Parents GA/USA
Samira Alexandre Cardona 05/20/1992 Grandmother GA/USA
Xilena Katherrine Cardona 12/02/1994 Grandmother GA/USA

Former Spouse 1 Information

Last
Cardona
First
Alexander
DOB
09/19/1971
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. Manzo
Data Entry
K. Aleman
Referred By
Damaryz