ESP-MIR-67

Code
ESP-MIR-67
Mercy ID
V-03221-01
Encounter Date
12/08/2009
Last
Espinal
First
Mirtha
DOB
07/10/1967
County
Cherokee
Street
204 Ridgepoint Ct.
City
Woodstock
State
GA
Zip
30189-
Cell
(678) 600-9196
Family Status
Single adult
COB
Dominican Rep
Gender
Female
Housing
Single Family
Education Level
Some College

Spouse Information

Last
Espinal
First
Ramon
DOB
05/15/1940
Address
N/A
Telephone
N/A
COB
Dominican Rep
Home Owner
YES
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
YES
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
Hijos den D. R. N/A N/A GA/USA

Former Spouse 1 Information

Last
Espinal
First
Ramon
DOB
05/15/1940
Telephone
N/A
COB
Dominica Rep.
Home Owner
YES
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-Juana