PER-MAR-78

Code
PER-MAR-78
Mercy ID
V-02104-01
Encounter Date
12/01/2005
Last
Perez mata
First
Maria guadalupe
DOB
06/10/1978
County
Gwinnett
Street
266 Highmarket Lane
City
Lawrenceville
State
GA
Zip
30045-
Home
(770) 873-6819
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Some College

Spouse Information

Last
Moreno
First
Jose cruz
DOB
05/03/1977
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
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
Jose Cruz Moreno 08/29/2004 Mother GA/USA
Obdulia G Perez 11/22/2000 Mother 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
Linea 375