NAM-TEO-78

Code
NAM-TEO-78
Mercy ID
V-03350-01
Encounter Date
06/23/2010
Last
Nambo
First
Teodora
DOB
12/27/1978
County
Gwinnett
Street
1021 Rockbridge Rd.
City
Norcross
State
GA
Zip
30093-
Cell
(678) 634-2919
Family Status
Child/Youth
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade school

Spouse Information

Last
Mondragon
First
Felipe
DOB
05/26/1979
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
YES
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
Alejandro Mondragon 08/26/2001 Mother GA/USA
Cristina Mondragon 04/21/1998 Mother GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
YES
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
walk-in