GNZ-MIR-72

Code
GNZ-MIR-72
Mercy ID
V-03218-01
Encounter Date
12/03/2009
Last
Gonzalez
First
Mirtha
DOB
10/03/1972
County
Dekalb
Street
2990 Shallowford Road
City
Chamblee
State
GA
Zip
30341-
Cell
(404) 914-8452
Family Status
Single parent w/children
COB
Perú
Gender
Female
Housing
Doubling Up
Education Level
Grade 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
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
Georfon Huaythlla 10/01/2000 Mother GA/USA
Melanny Huaythlla 10/07/2005 Mother GA/USA
Thamir Huaythlla 05/12/1998 Mother GA/USA

Former Spouse 1 Information

Last
Huaythlla
First
Marcial
DOB
09/09/1999
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
2