MEN-ORT-77

Code
MEN-ORT-77
Mercy ID
V-02277-01
Encounter Date
05/23/2006
Last
Mendez
First
Hortencia
DOB
01/11/1977
County
Gwinnett
Street
1120 Forest Valley
City
Norcross
State
GA
Zip
00000-
Home
(770) 935-5227
Other
(678) 249-8724
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Escamilla
First
Simon
DOB
01/19/1977
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
YES
Gwinnett
Alcohol & Drug
No
Partner Referred to Tepestri
No
Recidivism/Court
No
New Incident
No
Promesa de Confidencialidad
YES
Consentimiento De Participar
YES

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
Cristopher Escamilla 03/01/2000 Parents GA/USA
Jessica Escamilla 09/29/1998 Parents GA/USA
Samanta Escamilla 11/17/2004 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