CER-MAR-75

Code
CER-MAR-75
Mercy ID
V-02185-01
Encounter Date
02/22/2006
Last
Cervantes
First
Maribel
DOB
12/12/1975
County
Gwinnett
Street
Old Norcross
City
Norcross
State
GA
Zip
30096-
Home
(770) 368-7419
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Solano
First
Carlos
DOB
02/26/1981
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
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
Karla Solano 06/22/1998 Grandmother Mexico
Yenifer Solano 11/05/2003 Grandmother Mexico

Former Spouse 1 Information

Last
Rosales
First
Ricardo
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
Walk in