HER-GUA-78

Code
HER-GUA-78
Mercy ID
V-03267-01
Encounter Date
02/23/2010
Last
Hernandez
First
Guadalupe
DOB
08/04/1978
County
Forsyth
Street
1085 Homesteaders Road # 85
City
Cumming
State
GA
Zip
30041-
Cell
(678) 600-7626
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade school

Spouse Information

Last
Hernandez
First
Jose
DOB
07/16/1971
Address
N/A
Telephone
N/A
COB
Mexico
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
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
Alexis Hernandez 09/12/2004 Parents GA/USA
Litzy Hernandez 10/27/2000 Parents GA/USA
Tania Hernandez 04/24/1999 Parents GA/USA
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