MAG-MAR-76

Code
MAG-MAR-76
Mercy ID
V-03112-01
Encounter Date
07/01/2009
Last
Barrientos
First
Maria
DOB
02/21/1976
County
Rockdale
Street
952 Northridge Dr.
City
Coneyrs
State
GA
Zip
30012-
Cell
(678) 997-5482
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high 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
Natalie Barrientos 01/12/2009 Mother GA/USA

Former Spouse 1 Information

Last
Cunningham
First
Shaun
DOB
04/02/1986
Telephone
N/A
COB
USA
Home Owner
No

Former Spouse 2 Information

Last
L?????????????????????????????
First
L?????????????????????????????
DOB
N/A
Telephone
N/A
COB
N/A
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
YES
Intake
J. Perez
Data Entry
J. Manzo
Referred By
linea-Juana