MAR-MIC-84

Code
MAR-MIC-84
Mercy ID
V-03257-02
Encounter Date
02/16/2010
Last
Martinez
First
Michel
DOB
12/17/1984
County
Fulton
Street
185 Collier Road Apt. 4-D
City
Atlanta
State
GA
Zip
30318-
Cell
(404) 914-7392
Family Status
Single adult
COB
Mexico
Gender
Male
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
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
YES
Program Completed
YES
DFCS Mandated
No
Alcohol & Drug
YES
1
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
YES
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
Kelsey Martinez 12/30/2009 Mother GA/USA

Former Spouse 1 Information

Last
Aguilera
First
Dolis
DOB
10/20/1987
Telephone
N/A
COB
USA
Home Owner
YES
NOTES

Media Authoritation

DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
J. Manzo
Referred By
Fulton Cty/linea-Juana