MOR-SUS-64

Code
MOR-SUS-64
Mercy ID
V-00223-01
Encounter Date
05/24/2000
Last
Moreira
First
Susana
DOB
05/24/2000
County
Gwinnett
Street
974 Pepperwood Trail
City
Norcross
State
GA
Zip
30093-
Home
(678) 380-5780
Family Status
Single parent w/children
COB
Nicaragua
Gender
Female Child
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
King
First
Mustafa
DOB
01/02/1950
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
YES
Driver
No
Home Owner
YES
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
Melisa Jacoba Moreira King 05/25/1997 Mother GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
Y. Garcia
Referred By