CAD-MIR-82

Code
CAD-MIR-82
Mercy ID
V-03315-01
Encounter Date
05/03/2010
Last
Caldelas
First
Mireya
DOB
02/17/1982
County
Rockdale
Street
1103 Mill Crest Dr.
City
Conyers
State
GA
Zip
30012-
Cell
(678) 791-2115
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Adult, no formal education

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
Erendida Marquez 10/17/1997 Mother GA/USA
Katy N. Marquez 10/18/2008 Mother GA/USA
Rebeca Marquez 02/26/2004 Mother GA/USA

Former Spouse 1 Information

Last
Marquez
First
Jose
DOB
10/27/1977
Telephone
N/A
COB
Mexico
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