CAS-ADR-79

Code
CAS-ADR-79
Mercy ID
V-02995-01
Encounter Date
02/03/2009
Last
Casimiro
First
Adriana
DOB
12/09/1979
County
Polk
Street
522 Fcave Spring
City
Cedartown
State
GA
Zip
30125-
Home
(770) 748-7325
Cell
(678) 988-2865
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
Ortiz
First
Adan
DOB
10/02/1976
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
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
Adan Ortiz 06/03/2006 Parents GA/USA
Alondra B. Ortiz 09/26/1999 Parents GA/USA
Jennifer Ortiz 05/12/2004 Parents GA/USA
Kimberly Ortiz 09/10/2001 Parents 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
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