ORT-LUC-79

Code
ORT-LUC-79
Mercy ID
V-02192-01
Encounter Date
03/08/2006
Last
Ortiz
First
Lucero
DOB
06/22/1979
County
Rockdale
Street
not given
City
Conyers
State
GA
Zip
00000-
Home
(678) 413-2005
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Shelter
Education Level
Adult, no formal education

Spouse Information

Last
Estevan ordaz
First
Hipolito
DOB
03/20/1967
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
Cristian Estevan 06/28/1997 Mother GA/USA
Emanuel Estevan 05/10/2001 Mother GA/USA
Ivan Estevan 06/28/1997 Mother GA/USA
Pamela A. Estevan 12/25/1995 Mother GA/USA
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
Fabiola Gomez