FAR-MIO-79

Code
FAR-MIO-79
Mercy ID
V-01846-01
Encounter Date
03/01/2005
Last
Farias
First
Miosotis
DOB
04/28/1979
County
Gwinnett
Street
1100 Indian Trail Rd.
City
Norcross
State
GA
Zip
30093-
Cell
(678) 698-0800
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
College Degree

Spouse Information

Last
Pavon
First
Victor M.
DOB
02/09/1981
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
No
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
Jailyn Nancy 01/13/1998 Mother GA/USA
Jason Farias 01/30/2002 Mother GA/USA
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
Rafael Miranda