MAR-MON-73

Code
MAR-MON-73
Mercy ID
V-02959-01
Encounter Date
12/08/2008
Last
Martinez
First
Monica
DOB
04/11/1973
County
Gwinnett
Street
5578 Executive Way
City
Norcross
State
GA
Zip
30071-
Home
(770) 903-4787
Cell
(678) 524-8574
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
High school graduate

Spouse Information

Last
Martinez
First
Jorge
Middle
A.
DOB
03/14/1976
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
Jorge A. Martinez 12/13/1999 Mother GA/USA
Zamara Martinez 05/21/1995 Mother GA/USA
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
Asociacion Latina