BRA-ELV-77

Code
BRA-ELV-77
Mercy ID
V-02300-01
Encounter Date
07/05/2006
Last
Brambila
First
Elvia
DOB
09/14/1977
County
Gwinnett
Street
93 Benson St.
City
Lawrenceville
State
GA
Zip
30045-
Home
(770) 963-3571
Family Status
Two parent family w/children
COB
Mexico

Spouse Information

Last
Mendez
First
Eduardo
DOB
12/29/1973
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
YES

Children

NAME DOB LIVING WITH STATE/COUNTRY
Eduardo Mendez 03/30/2000 Parents GA/USA
Evelin Mendez 06/21/2003 Parents GA/USA
Irvin Mendez 04/19/1994 Parents GA/USA
Mirella Mendez 01/21/2002 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
J. Manzo
Referred By
Linea