ESC-SIM-77

Code
ESC-SIM-77
Mercy ID
V-02277-02
Encounter Date
07/03/2006
Last
Escamilla
First
Simon
DOB
01/19/1977
County
Gwinnett
Street
2440 C Winsor Woods Ln.
City
Norcross
State
GA
Zip
30071-
Cell
(678) 249-8724
Family Status
Two parent family w/children
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Mendez
First
Hortencia
DOB
01/11/1977
Address
N/A
Telephone
(770) 935-5227
COB
Mexico
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
No
Program Completed
No
DFCS Mandated
YES
Gwinnett
Alcohol & Drug
YES
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
Cristopher 03/01/2000 Mother GA/USA
Jessica 09/29/1999 Mother GA/USA
Samantha N/A Mother 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
J. Manzo
Referred By
DFCS Gwinnett