MAR-ELI-72

Code
MAR-ELI-72
Mercy ID
V-02149-01
Encounter Date
01/04/2006
Last
Martinez
First
Elimey
DOB
07/09/1972
County
Dekalb
Street
3415 Shallowford Road
City
Doraville
State
GA
Zip
30340-
Cell
(678) 849-7141
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
Juarez
First
Efren
DOB
06/18/1965
Address
N/A
Telephone
(404) 573-2357
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
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
Alma Josefina San Gabriel 10/21/1992 Mother w/Stepfather México
Juan Manuel Sarabia 06/12/1995 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
San gabriel
First
Noel
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
Felipe Perez