MAR-PAT-60

Code
MAR-PAT-60
Mercy ID
V-01718-01
Encounter Date
10/08/2004
Last
Martinez
First
Patricia
DOB
06/29/1960
County
Gwinnett
Street
2975 Sentinel Pkway
City
Lawrenceville
State
GA
Zip
30043-
Cell
(678) 768-2507
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Vocational/Technical

Spouse Information

Last
Ortiz
First
Javier
DOB
10/10/1959
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
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
Elizabeth Ortiz 09/17/1990 Parents GA/USA
Javier Ortiz 08/14/1997 Parents GA/USA
Zayda Ortiz 03/12/1979 Parents 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
Walk-in/CMS