GUE-BER-69

Code
GUE-BER-69
Mercy ID
V-03450-01
Encounter Date
11/08/2010
Last
Guevara
First
Berta
DOB
09/28/1969
County
Dekalb
Street
2561 New Bedford Ln. # F
City
Atlanta
State
GA
Zip
30319-
Cell
(404) 207-6534
Family Status
Single parent w/children
COB
El Salvador
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
YES
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
Adolfo Guevara 04/22/2000 Mother GA/USA

Former Spouse 1 Information

Last
Rivera
First
Nery
DOB
07/01/1976
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
Jacqueline