PER-MAR-72

Code
PER-MAR-72
Mercy ID
V-03484-01
Encounter Date
12/10/2010
Last
Perez
First
Martha
DOB
04/25/1972
County
Gwinnett
Street
2169 Summer Town
City
Norcross
State
GA
Zip
30071-
Cell
(678) 509-4143
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade 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
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
Alexis Mendez 09/23/1999 Mother GA/USA
Butsy Garcia 10/20/2008 Mother GA/USA
Hevolet Garcia 12/11/2009 Mother GA/USA

Former Spouse 1 Information

Last
Garcia
First
Juan
DOB
06/24/1976
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES

Media Authoritation

NO 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