HER-VIC-74

Code
HER-VIC-74
Mercy ID
V-02706-01
Encounter Date
02/06/2008
Last
Hernandez
First
Victorina
DOB
07/28/1974
County
Fulton
Street
88 Old Holcomb Bridge
City
Roswell
State
GA
Zip
30076-
Home
(770) 710-0605
Cell
(770) 374-4887
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
Mexico
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
YES
Program Completed
No
DFCS Mandated
No
Alcohol & Drug
No
Partner Referred to Tepestri
No
Recidivism/Court
No
New Incident
No
Promesa de Confidencialidad
YES
Consentimiento De Participar
YES

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
Hiram Hernandez 01/26/1997 Mother GA/USA
Jose Manuel Chona 11/27/1991 Mother GA/USA
Josue Samuel Chona 05/04/1994 Mother GA/USA

Former Spouse 1 Information

Last
Domeinguez
First
Francisco
DOB
12/03/1973
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES
***INCIDENTE CON EL HIJO JOSE MANUEL CHONA****

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