HER-MRI-68

Code
HER-MRI-68
Mercy ID
V-02552-01
Encounter Date
07/25/2007
Last
Hernandez
First
Maria del carmen
DOB
09/16/1968
County
Hall
Street
461 Northside Apt. A
City
Gainsville
State
GA
Zip
30501-
Home
(770) 536-8496
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
some high school

Spouse Information

Last
Aquino
First
Manuel
DOB
09/11/1969
Address
N/A
Telephone
N/A
COB
El Salvador
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
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Israel Leal 03/20/1992 N/A GA/USA
Jonathan Leal 02/23/1996 N/A GA/USA
Marisol Leal Hernandez 12/18/1989 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Leal
First
Israel
DOB
05/06/1966
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
J. Perez
Data Entry
J. Manzo
Referred By
Linea-radio