SAN-MAR-15

Code
SAN-MAR-15
Mercy ID
V-02016-01
Encounter Date
09/06/2005
Last
Sanjuan
First
Marcia
DOB
03/15/1966
County
Fulton
Street
1334 Jeferson Dr.
City
Atlanta
State
GA
Zip
30350-
Home
(404) 399-4880
Family Status
Adult coupie-no children
COB
Colombia
Gender
Female
Housing
Not Homeless
Education Level
Some College

Spouse Information

Last
Grimberg
First
Carlos
DOB
N/A
Address
N/A
Telephone
N/A
COB
Colombia
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
Carolina Rocha 02/24/1985 Father GA/USA
Samuel Grimber 08/30/1996 Father 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
R. Gonzalez
Referred By