MAT-ALB-77

Code
MAT-ALB-77
Mercy ID
V-02429-01
Encounter Date
03/02/2007
Last
Matias
First
Alberta
DOB
04/21/1977
County
Dekalb
Street
5 Pearl Lane
City
Chamblee
State
GA
Zip
30341-
Cell
(678) 368-1154
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
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
YES
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
Cesar Hernandez 08/26/1993 Grandmother Mexico
Luis Angel Hernandez 02/21/1996 Grandmother Mexico

Former Spouse 1 Information

Last
Gomez
First
Miguel
DOB
N/A
Telephone
N/A
COB
Guatemala
Home Owner
No
NOTES
4/9/08, ref. a Asoc. Lat.

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
J. Manzo
Referred By
linea-Juana