MAG-PAT-76

Code
MAG-PAT-76
Mercy ID
V-03176-01
Encounter Date
09/28/2009
Last
Magaña
First
Patricia
DOB
11/19/1976
County
Hall
Street
9999 En una Iglesia
City
Gainsville
State
GA
Zip
30501-
Cell
(678) 989-9861
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Other
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
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
Arath Amado 11/29/2001 Mother GA/USA
Arlett Amado 06/19/2003 Mother GA/USA
Brandon Amado 08/12/2006 Mother GA/USA

Former Spouse 1 Information

Last
Amado benitez
First
Jose antonio
DOB
12/22/1977
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
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
linea-Griselda