PER-OLG-77

Code
PER-OLG-77
Mercy ID
V-02801-01
Encounter Date
05/27/2008
Last
Perez
First
Olga
DOB
03/22/1977
County
Fulton
Street
1505 Chanel Ave. Lot 41
City
Marietta
State
GA
Zip
30318-
Home
(404) 351-7261
Other
(404) 604-3005
Family Status
Two parent family w/children
COB
Dominican Rep
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
Crusillo
First
Mario
DOB
01/20/1969
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
YES
Consentimiento De Participar
YES

Petitioner

TPO
No
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
Gregorio Perez 11/17/1997 Mother w/Stepfather GA/USA
Joseph Perez 11/22/2005 Parents GA/USA
Rachell Perez 10/31/2001 Parents GA/USA
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