GAR-HIL-74

Code
GAR-HIL-74
Mercy ID
V-02694-01
Encounter Date
01/17/2008
Last
Garcia
First
Hilda
DOB
03/05/1974
County
Cobb
Street
297 Sand Hurft Way
City
Marietta
State
GA
Zip
30060-
Home
(770) 805-9381
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
H.S. equivalency diploma

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
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
Eduardo Martinez 03/29/2002 Mother GA/USA
Jessica Martinez 04/02/2001 Mother GA/USA
Keyla Martinez 10/21/1996 Mother GA/USA

Former Spouse 1 Information

Last
Martinez
First
Jorge
DOB
02/02/1977
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-Juana