CAN-ELV-78

Code
CAN-ELV-78
Mercy ID
V-01755-01
Encounter Date
11/12/2004
Last
Cano
First
Elvira
DOB
02/04/1978
County
Gwinnett
Street
1703 Tree Trail Pkwy
City
Norcross
State
GA
Zip
30093-
Cell
(404) 749-7632
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Vocational/Technical

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
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
YES
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
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Dariel Cano 05/21/1998 Mother GA/USA
Isabela Cardona 06/11/2009 Mother GA/USA
Rolando Cardona 01/08/2003 Mother GA/USA

Former Spouse 1 Information

Last
Cardona
First
Ricardo
DOB
08/05/1976
Telephone
N/A
COB
Mexico
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
Corte Gw/Damaryz