PIC-LIR-65

Code
PIC-LIR-65
Mercy ID
V-00147-01
Encounter Date
03/15/2000
Last
Picado
First
Lirise
DOB
07/12/1965
County
Cobb
Street
2560 Delk Rd Apt G-15
City
Marietta
State
GA
Zip
30067-
Home
(770) 457-1290
Family Status
Two parent family w/children
COB
Nicaragua
Gender
Female
Housing
Doubling Up
Education Level
Child, not in school

Spouse Information

Last
Langston
First
Brian
DOB
11/02/1958
Address
N/A
Telephone
N/A
COB
EEUU
Home Owner
No
Driver
No
Home Owner
YES
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
Machael langston N/A N/A GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
D. Gomez
Referred By