PAL-SAN-72

Code
PAL-SAN-72
Mercy ID
V-02860-01
Encounter Date
07/28/2008
Last
Palacio
First
Sandra
DOB
02/28/1972
County
Gwinnett
Street
1800 Herrington Wood Ct. # 407
City
Lawrenceville
State
GA
Zip
30044-
Cell
(678) 768-9882
Family Status
Single parent w/children
COB
Colombia
Gender
Female
Housing
Doubling Up
Education Level
High school graduate

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
YES
Consentimiento De Participar
YES

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
Jessica Ochoa 04/17/1994 Mother GA/USA
Yesenia Ochoa 02/21/2003 Mother GA/USA

Former Spouse 1 Information

Last
Ochoa
First
William
DOB
03/12/1967
Telephone
N/A
COB
N/A
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
J. Manzo
Referred By
linea-Juana