MAR-SYN-77

Code
MAR-SYN-77
Mercy ID
V-02055-02
Encounter Date
10/11/2005
Last
Martinez
First
Ynocencio
DOB
06/22/1977
County
Fulton
Street
66 Northwood Dr. Apt 138
City
Atlanta
State
GA
Zip
30342-
Home
(404) 256-3414
Work
(404) 256-3040
Family Status
Two parent family w/children
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
High school graduate

Spouse Information

Last
Hernandez
First
Giesi
DOB
10/06/1982
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
No
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
Katherin Martinez 11/06/2004 Parents GA/USA
Lesly Nikol Martinez 07/08/2003 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
R. Miranda
Data Entry
R. Gonzalez
Referred By