MED-MAR-69

Code
MED-MAR-69
Mercy ID
V-02208-01
Encounter Date
03/03/2006
Last
Medina
First
Maria
DOB
08/09/1969
County
Fulton
Street
2010 Curtis Dr #11
City
Atlanta
State
GA
Zip
30319-
Home
(404) 235-4013
Cell
(678) 437-0929
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Salas
First
Leon
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
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
Ana Rosa Salas 03/25/1988 Parents GA/USA
Gabriela Salas 08/14/1993 Parents GA/USA
Griselda Salas 02/08/1989 Parents GA/USA
Hugo Alberto Salas 03/29/1992 Parents 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
Linea