MAS-CRI-82

Code
MAS-CRI-82
Mercy ID
V-02113-01
Encounter Date
10/29/2005
Last
Masterson
First
Crystal
DOB
06/07/1982
County
Gwinnett
Street
2906 Spruce Circle
City
Snellville
State
GA
Zip
30045-
Home
(678) 368-5553
Cell
(678) 760-2813
Family Status
Two parent family w/children
COB
USA
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Popoca sanchez
First
Jose angel
DOB
08/01/1984
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
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
Angelica Popoca 09/01/2004 Parents GA/USA
Deisy Sorto 09/25/2002 Mother GA/USA

Former Spouse 1 Information

Last
Sorto
First
Luis
DOB
N/A
Telephone
N/A
COB
N/A
Home Owner
No
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
Rafael Miranda