ACO-SUS-76

Code
ACO-SUS-76
Mercy ID
V-03467-01
Encounter Date
12/01/2010
Last
Acoltzi
First
Susana
DOB
02/22/1976
County
Fulton
Street
3360 Penny Lane Apt H
City
East point
State
GA
Zip
30344-
Cell
(817) 350-9064
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
College Degree

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
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
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
Emanuel Cortez 10/09/2002 Mother GA/USA
Genesis Cortez 12/14/2006 Mother GA/USA
Jordan R. Cortez 06/13/1995 Mother GA/USA
Josue Cortez 12/27/2004 Mother GA/USA

Former Spouse 1 Information

Last
Cortez
First
Ricardo
DOB
12/19/1969
Telephone
N/A
COB
Mexico
Home Owner
YES
NOTES

Media Authoritation

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