MOR-BER-63

Code
MOR-BER-63
Mercy ID
V-03150-01
Encounter Date
08/31/2009
Last
Moreno
First
Bertha
DOB
07/23/1963
County
Gwinnett
Street
1624 Watercrest
City
Lawrenceville
State
GA
Zip
30043-
Cell
(678) 693-0257
Family Status
Single parent w/children
COB
USA
Gender
Female
Housing
Single Family
Education Level
Some College

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
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
Catherine Camayo 12/16/1993 Mother GA/USA
Juan Camayo 09/12/1996 Mother GA/USA

Former Spouse 1 Information

Last
Halloow
First
Mike
DOB
02/25/1956
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
J. Perez
Data Entry
J. Manzo
Referred By
linea-Juana/ALA