QUI-MAR-63

Code
QUI-MAR-63
Mercy ID
V-03261-01
Encounter Date
02/12/2010
Last
Quiroz
First
Maria noelia
DOB
10/10/1963
County
Gwinnett
Street
999 no la quiso dar
City
Norcross
State
GA
Zip
99999-
Cell
(914) 882-9390
Family Status
Single parent w/children
COB
Colombia
Gender
Female
Housing
Single Family
Education Level
Some College

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
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
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
Daniel Jiraldo N/A Grandmother GA/USA

Former Spouse 1 Information

Last
Lopez
First
Roberto
DOB
N/A
Telephone
N/A
COB
Colombia
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