SAN-OTI-81

Code
SAN-OTI-81
Mercy ID
V-03197-01
Encounter Date
10/27/2009
Last
Santiago
First
Otilia
DOB
06/29/1981
County
Clayton
Street
843 Warrant Drive
City
Forest park
State
GA
Zip
30297-
Cell
(404) 963-1357
Other
(678) 456-1481
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
YES
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
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
Joanna Santiaga 10/19/1997 Mother GA/USA
Luis Medellin 11/24/2004 Mother GA/USA
Roxana Medellin 04/02/2002 Mother GA/USA
Uriana Medellin 06/26/2003 Mother GA/USA

Former Spouse 1 Information

Last
Medellin
First
Jose
DOB
07/07/1978
Telephone
N/A
COB
Mexico
Home Owner
No
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