GRE-ADR-71

Code
GRE-ADR-71
Mercy ID
V-03189-01
Encounter Date
10/14/2009
Last
Green
First
Adriana
DOB
08/20/1971
County
Gwinnett
Street
4361 Meadow Dr.
City
Duluth
State
GA
Zip
30096-
Cell
(678) 234-9956
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
College Degree

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
Christopher Andre Green 11/16/2008 Mother GA/USA
Shannon Peniche 01/22/1994 Grandparents Mexico - Maternos

Former Spouse 1 Information

Last
Green
First
Bruce
DOB
01/14/1966
Telephone
N/A
COB
USA
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/ Maria Miller School