HER-ISA-74

Code
HER-ISA-74
Mercy ID
V-01721-01
Encounter Date
10/01/2004
Last
Hernandez
First
Isabel
DOB
08/14/1974
County
Cobb
Street
648 Armstrong St. Apt B
City
Marietta
State
GA
Zip
30060-
Home
(678) 355-5365
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Hernandez
First
Jorge
DOB
04/23/1971
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
YES
Relative
YES
Stranger
No
As An Adult
YES
Partner
No
Relative
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Gabriela Hernandez 04/19/1992 Parents GA/USA
Jorge Hernandez 12/17/1999 Parents GA/USA
Maribel Hernandez 08/30/1996 Parents GA/USA
Maritza Hernandez 02/17/1995 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