PER-ANA-73

Code
PER-ANA-73
Mercy ID
V-02110-01
Encounter Date
10/29/2005
Last
Perez
First
Ana maria
DOB
03/11/1973
County
Dekalb
Street
3028 Chamblee Tucker Road Apt. N-6
City
Chamblee
State
GA
Zip
30341-
Cell
(678) 973-8439
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade school

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
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
YES
Consentimiento De Participar
YES

Petitioner

TPO
YES
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
Ana K. Perez 09/06/1993 Parents GA/USA
Andres Suarez 03/19/2004 Parents GA/USA
David Suarez 10/01/2002 Parents GA/USA
Isela Perez 10/19/1999 Parents GA/USA
Reyna Perez 01/06/1996 Parents GA/USA

Former Spouse 1 Information

Last
Suarez
First
David
DOB
04/03/1972
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES

Media Authoritation

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