MAY-MAR-73

Code
MAY-MAR-73
Mercy ID
V-03425-01
Encounter Date
09/15/2010
Last
Mayorga
First
Maria del rocio
DOB
07/06/1973
County
Dekalb
Street
6750 Peachtree Industrial Blv. Apt. 1211
City
Atlanta
State
GA
Zip
30360-
Cell
(404) 552-2071
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school

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
YES
Consentimiento De Participar
YES

Petitioner

TPO
YES
Stay Away Condition
No
Mutual
No

Defendant

TPO
No
Stay Away Condition
No
Mutual
No
Driver
YES
As A Child
No
Relative
YES
Stranger
YES
As An Adult
No
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Bryan Mejia 10/18/1998 Mother GA/USA
Evelyn Mejia 10/21/2003 Mother GA/USA
Noe Mejia 02/27/2000 Parents GA/USA

Former Spouse 1 Information

Last
Mejia
First
Rene
DOB
11/25/1974
Telephone
N/A
COB
Honduras
Home Owner
YES
NOTES

Media Authoritation

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