PAL-DOR-83

Code
PAL-DOR-83
Mercy ID
V-03317-01
Encounter Date
05/03/2010
Last
Palma
First
Dora
DOB
05/08/1983
County
Clayton
Street
4257 Sierra Dr.
City
Forest park
State
GA
Zip
30297-
Cell
(404) 748-0013
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Garcia
First
Luis
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
YES
As A Child
YES
Relative
YES
Stranger
No
As An Adult
YES
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Carolyne M. Razam 01/29/2005 Father GA/USA
Edwin M. Razam 12/10/2007 Father GA/USA

Former Spouse 1 Information

Last
Razam
First
Manuel
DOB
05/01/1974
Telephone
N/A
COB
Guatemala
Home Owner
No
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