LEO-ESP-59

Code
LEO-ESP-59
Mercy ID
V-01972-01
Encounter Date
04/22/1999
Last
Leon
First
Esperanza
DOB
12/08/1959
County
Other
Street
not given
City
Other
State
GA
Zip
00000-000
Home
(000) 000-0000
Family Status
Two parent family w/children
COB
Mexico
Gender
Female

Spouse Information

Last
N/A
First
Ernesto
DOB
N/A
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
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
Alejandra N/A N/A GA/USA
Andres N/A N/A GA/USA
Arturo N/A N/A GA/USA
Juan N/A N/A 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