EST-CEV-60

Code
EST-CEV-60
Mercy ID
V-03073-01
Encounter Date
05/18/2009
Last
Estrada
First
Severa
DOB
11/08/1960
County
Dekalb
Street
760 Ridge Ave.
City
Stone mountain
State
GA
Zip
30083-
Cell
(404) 516-7195
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
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
YES
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
Abrahan Jr. Estrada 04/07/1991 Mother GA/USA
Sara Estrada 06/25/1994 Mother GA/USA
Valentin Estrada 01/15/1997 Mother GA/USA

Former Spouse 1 Information

Last
Estrada
First
Abrahan
DOB
03/16/1960
Telephone
N/A
COB
N/A
Home Owner
YES
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-Juana