GUI-FUL-77

Code
GUI-FUL-77
Mercy ID
V-02678-01
Encounter Date
07/11/2008
Last
Guillen
First
Fulgencia
DOB
08/12/1977
County
Clayton
Street
276 Upperriverdale Road # 11 C
City
Jonesboro
State
GA
Zip
30236-
Cell
(678) 437-5442
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
Hernandez
First
Daniel
DOB
07/15/1963
Address
N/A
Telephone
N/A
COB
Dominican Rep
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
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