HER-MIR-30

Code
HER-MIR-30
Mercy ID
V-02061-01
Encounter Date
10/16/2005
Last
Hernandez
First
Mirna lilian
DOB
11/30/1972
County
Dekalb
Street
1215 Bruckett Way
City
Clarkston
State
GA
Zip
30021-
Cell
(678) 410-3359
Family Status
Single parent w/children
COB
El Salvador
Gender
Female
Housing
Doubling Up
Education Level
Vocational/Technical

Spouse Information

Last
Reyes
First
Abel. A
DOB
11/24/1979
Address
N/A
Telephone
N/A
COB
USA
Home Owner
YES
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
YES
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
Abel Alejandro Reyes 03/16/2001 Mother GA/USA
NOTES
Code ends w/the woman's day of birth. Another woman in system w/similar name has same code w/same year.

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