CER-MAR-74

Code
CER-MAR-74
Mercy ID
V-03376-01
Encounter Date
08/09/2010
Last
Cervantes
First
Maria francisca
DOB
03/21/1974
County
Dekalb
Street
2200 Plaster Rd.
City
Atlanta
State
GA
Zip
30345-
Cell
(404) 563-3433
Family Status
Single parent w/children
COB
Guatemala
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
YES
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
Owven Galicia 09/07/2007 Mother GA/USA
Rosalinda Galicia 05/10/2003 Mother GA/USA

Former Spouse 1 Information

Last
Galicia
First
Hector
DOB
11/05/1968
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
J. Perez
Data Entry
J. Manzo
Referred By
linea- Juana