MEN-ERI-75

Code
MEN-ERI-75
Mercy ID
V-02634-01
Encounter Date
10/27/2007
Last
Mendoza
First
Erica
DOB
04/26/1975
County
Dekalb
Street
1024 Oak Chase Drive Apt. O
City
Tucker
State
GA
Zip
30084-
Cell
(770) 875-0724
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high 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
Alexis Lagunes 07/31/1999 Mother GA/USA
Neftaly Alegria 06/19/1997 Mother GA/USA
Salvador Lagunes 07/31/2000 Mother GA/USA
Samara Saenz 08/06/2003 Mother GA/USA

Former Spouse 1 Information

Last
Lagunes
First
Salvador
DOB
08/20/1972
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