MAR-BER-77

Code
MAR-BER-77
Mercy ID
V-02546-01
Encounter Date
07/07/2007
Last
Martinez
First
Bertha
DOB
11/07/1977
County
Habersham
Street
303 Pine Hill Rd.
City
Cornelia
State
GA
Zip
99999-9999
Other
(404) 785-0374
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
N/A
First
N/A
DOB
N/A
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
YES
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
Daniela Flores 01/29/2000 Mother GA/USA
Johana Flores 02/15/2001 Mother GA/USA
Mariela Flores 12/17/2001 Mother GA/USA
Nancy Flores 05/11/1994 Mother GA/USA

Former Spouse 1 Information

Last
Flores
First
Ramon salomon
DOB
11/25/1975
Telephone
N/A
COB
mexico
Home Owner
No
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-Juana