JUA-MIR-80

Code
JUA-MIR-80
Mercy ID
V-02129-01
Encounter Date
12/30/2005
Last
Juarez
First
Mirtala
DOB
05/21/1980
County
Dekalb
Street
3510 Buford Hwy Apt t 5
City
Atlanta
State
GA
Zip
30329-1322
Family Status
Single parent w/children
COB
Guatemala
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Reyes
First
Miguel
DOB
02/23/1982
Address
N/A
Telephone
N/A
COB
El Salvador
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
YES
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
Heidi Marisol 11/11/1998 Grandmother Guatemala

Former Spouse 1 Information

Last
Osorio
First
Federico
DOB
N/A
Telephone
N/A
COB
N/A
Home Owner
No
NOTES
Wrong #'s (404) 957-2658 & (404) 551-8687

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
Felipe Perez