SAN-MAR-80

Code
SAN-MAR-80
Mercy ID
V-02054-01
Encounter Date
09/22/2005
Last
Santa maria
First
Martha
DOB
02/16/1980
County
Gwinnett
Street
5910 Hickory
City
Norcross
State
GA
Zip
30071-
Home
(678) 475-7414
Family Status
Two parent family w/children
COB
Ecuador
Gender
Female
Housing
Not Homeless
Education Level
Some College

Spouse Information

Last
Anecillas
First
Felipe
DOB
07/14/1976
Address
N/A
Telephone
N/A
COB
Ecuador
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
Emely Avecillas 07/13/2004 Parents GA/USA
Estart Avecillas 10/29/2001 Parents 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
R. Gonzalez
Referred By