MEN-SAM-69

Code
MEN-SAM-69
Mercy ID
V-02169-02
Encounter Date
02/28/2006
Last
Mendiola
First
Samuel
DOB
06/05/1969
County
Dekalb
Street
3234 Oakwood Village #D
City
Chamblee
State
GA
Zip
30341-
Home
(770) 451-9773
Work
(404) 217-4245
Family Status
Two parent family w/children
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Mendiola
First
Karina
DOB
11/15/1976
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
YES
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
Joan Mendiola 05/14/2002 Parents GA/USA
Sofia Mendiola 09/13/2005 Parents GA/USA
NOTES

Media Authoritation

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