MEN-MER-67

Code
MEN-MER-67
Mercy ID
V-03074-01
Encounter Date
05/18/2009
Last
Mencos
First
Mercedes
DOB
11/22/1967
County
Gordon
Street
2510 Peachtree Road # 18
City
Calhoun
State
GA
Zip
30701-
Cell
(678) 848-0484
Family Status
Single parent w/children
COB
El Salvador
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
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
Gabriel Loucel 11/16/2000 Mother GA/USA
Jeoreina Loucel 10/20/2003 Mother GA/USA
Jovana Loucel 08/01/2002 Mother GA/USA

Former Spouse 1 Information

Last
Loucel
First
Jose
DOB
N/A
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