MED-VER-77

Code
MED-VER-77
Mercy ID
V-02610-01
Encounter Date
10/03/2007
Last
Medina
First
Veronica
DOB
01/28/1977
County
Fulton
Street
6238 Cambell Road
City
Covington
State
GA
Zip
30040-
Cell
(678) 281-5507
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Maldonado
First
Jaime
DOB
06/13/1973
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
No
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
Alexis Maldonado 04/20/2007 Parents GA/USA
Jaime Maldonado 06/21/2002 Parents GA/USA
Jonathan Maldonado 02/06/2006 Parents GA/USA
Marlin Maldonado 01/26/2000 Parents GA/USA
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