HER-ELS-72

Code
HER-ELS-72
Mercy ID
V-02190-01
Encounter Date
03/09/2006
Last
Hernandez
First
Elsa maria
DOB
12/24/1972
County
Fulton
Street
400 Tidwell Rd
City
Alpharetta
State
GA
Zip
30004-
Home
(770) 410-0218
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Vocational/Technical

Spouse Information

Last
Rivera
First
Andres
DOB
05/25/1970
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
Andres Rivera 04/01/2005 Parents GA/USA
Fanny Rodriguez 04/28/1995 Grandmother Mexico
Isacc Rodriguez 09/19/1990 Grandmother Mexico
NOTES

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
Vio nuestro numero en un folleto.