CER-ESM-79

Code
CER-ESM-79
Mercy ID
V-00227-01
Encounter Date
02/24/2000
Last
Cervantes
First
Esmeralda
DOB
05/29/1979
County
Dekalb
Street
4009 covington rd
City
Covington
State
GA
Zip
30016-
Home
(770) 788-2205
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Shelter
Education Level
some high school

Spouse Information

Last
Gonzalez
First
Jose alfredo
DOB
06/12/1971
Address
same
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
diego alfredo 05/13/1996 Mother GA/USA
leidy gissell 05/21/1998 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
D. Gomez
Referred By
walk-in