HER-MIL-75

Code
HER-MIL-75
Mercy ID
V-01916-01
Encounter Date
06/06/2005
Last
Hernandez
First
Mildred
DOB
03/30/1975
County
Dekalb
Street
3061 Oll Rd. #77
City
Doraville
State
GA
Zip
30340-
Home
(770) 934-0731
Family Status
Single parent w/children
COB
Nicaragua
Gender
Female
Housing
Doubling Up
Education Level
Other

Spouse Information

Last
Espinal
First
Maximino
DOB
N/A
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
YES
Program Completed
YES
DFCS Mandated
No
Alcohol & Drug
No
Partner Referred to Tepestri
No
Recidivism/Court
No
New Incident
No
Promesa de Confidencialidad
No
Consentimiento De Participar
No

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
Valeria Camacho 05/07/1999 Mother GA/USA
Vanessa Camacho 05/07/1999 Mother GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
K. Aleman
Referred By