CON-GUI-86

Code
CON-GUI-86
Mercy ID
V-02650-01
Encounter Date
03/03/2008
Last
Contreras
First
Guillermina
DOB
11/12/1986
County
Dekalb
Street
102 Chamblee Dunwoody Apt. 102-4
City
Chamblee
State
GA
Zip
30341-
Cell
(678) 292-3581
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Adult, no formal education

Spouse Information

Last
Mondragon
First
Carlos
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
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
Alma Lucero 04/07/2001 Mother GA/USA
Diego Contreras 07/11/2000 Mother 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
J. Manzo
Referred By
St. Vincent of Paul/Ursula