SAR-MAD-71

Code
SAR-MAD-71
Mercy ID
V-03278-01
Encounter Date
03/09/2010
Last
Saravia
First
Madai
DOB
10/17/1971
County
Cherokee
Street
727 Peaks Lane
City
Acworth
State
GA
Zip
30102-
Cell
(678) 702-9148
Family Status
Single parent w/children
COB
Guatemala
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
Brandon Saravia 02/07/2001 Mother GA/USA
Erick A. Cervantes 08/09/1995 Mother GA/USA

Former Spouse 1 Information

Last
Saravia
First
Milton
DOB
02/20/1974
Telephone
N/A
COB
El Salvador
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
J. Manzo
Referred By
linea de info-Juana