HER-MAR-79

Code
HER-MAR-79
Mercy ID
V-02195-01
Encounter Date
03/07/2006
Last
Hernandez
First
Maria dolores
DOB
03/19/1979
County
Fulton
Street
not given
City
Carolina
State
GA
Zip
00000-
Cell
(404) 824-4779
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Diaz
First
Daniel
DOB
N/A
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
Jacqueline Diaz 12/12/2003 Mother GA/USA
Neil J Diaz 09/23/2001 Mother GA/USA
NOTES
Voluntaria

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
Rafael Miranda