MOR-IVA-84

Code
MOR-IVA-84
Mercy ID
V-02259-02
Encounter Date
06/12/2006
Last
Morales martinez
First
Ivan jacobo
DOB
08/03/1984
County
Dekalb
Street
3700 Buford Hwy Apt 91
City
Atlanta
State
GA
Zip
30329-
Home
(404) 292-0262
Cell
(678) 595-6419
Family Status
Two parent family w/children
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Altamarino
First
Guadalupe
DOB
12/12/1986
Address
N/A
Telephone
(404) 292-0262
COB
Mexico
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
YES
Program Completed
YES
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
Ivan Martinez 09/11/2005 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
F. Perez
Data Entry
R. Gonzalez
Referred By