PER-MAR-77

Code
PER-MAR-77
Mercy ID
V-02994-01
Encounter Date
01/28/2009
Last
Perez
First
Maria elena
DOB
10/09/1977
County
Cobb
Street
7311 Elsner Rd.
City
Austell
State
GA
Zip
30168-
Cell
(678) 260-7047
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade 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
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
Jesse Perez 06/25/2006 Mother GA/USA
Jorge Perez 04/23/1994 Mother GA/USA
Vanessa Perez 05/06/2000 Mother GA/USA

Former Spouse 1 Information

Last
Vega
First
Inocente
DOB
N/A
Telephone
N/A
COB
N/A
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
YES
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
C. Martinez
Data Entry
J. Manzo
Referred By
walk in -Zaida Ramirez