HER-DOR-73

Code
HER-DOR-73
Mercy ID
V-02660-01
Encounter Date
11/27/2007
Last
Hernandez
First
Dora
DOB
10/03/1973
County
Gwinnett
Street
2634 Dorian Dr. #-C
City
Snellville
State
GA
Zip
30078-
Home
(770) 736-4096
Cell
(678) 927-8657
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
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
Alexa Hernandez 06/27/2005 Mother GA/USA
Cesar Hernandez 10/08/1994 Mother GA/USA
Kevin Hernandez 03/18/1996 Mother GA/USA
Zaira Hernandez 04/17/1998 Mother GA/USA

Former Spouse 1 Information

Last
Hernandez
First
Cesar
DOB
04/07/1971
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-Griselda