CIS-BLA-77

Code
CIS-BLA-77
Mercy ID
V-01884-01
Encounter Date
04/25/2005
Last
Cisneros
First
Blanca estela
DOB
10/21/1977
County
Clayton
Street
669 Glendon Dr.
City
Morrow
State
GA
Zip
30260-
Home
(404) 399-0715
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Shelter
Education Level
Grade school

Spouse Information

Last
Hitron
First
Esteban
DOB
12/26/1977
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
No

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
YES
As An Adult
YES
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Maria Yaritza Martinez 12/26/1995 Aunt Mexico
Nisa Karime Martinez 01/30/1999 Aunt Mexico
NOTES
Sus niñas estan en Mexico

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
CJ William