ORT-IRI-88

Code
ORT-IRI-88
Mercy ID
V-02341-01
Encounter Date
09/27/2006
Last
Ortega
First
Iris
DOB
05/01/1988
County
Gwinnett
Street
3975 Dollar Cr.
City
Suwanee
State
GA
Zip
30324-
Home
(404) 248-2310
Cell
(404) 732-3994
Other
(404) 248-2310
Family Status
Two parent family w/children
COB
Guatemala
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Basaldo
First
Reinaldo
DOB
03/27/1985
Address
N/A
Telephone
N/A
COB
Venezuela
Home Owner
YES
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
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Fredy Garcia 03/27/2006 Grandmother Guatemala
Joshua Ortega 11/01/2007 Parents GA/USA

Former Spouse 1 Information

Last
Garcia
First
Carlos fernando
DOB
12/15/1981
Telephone
N/A
COB
Guatemala
Home Owner
No
NOTES
Tapestri la ref. la 2a. Vez

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-Juana