MIJ-COR-81

Code
MIJ-COR-81
Mercy ID
V-03488-01
Encounter Date
12/21/2010
Last
Mijares
First
Coralina
DOB
06/14/1981
County
Clayton
Street
3384 Mount Zion Rd. Apt. 107
City
Stockbridge
State
GA
Zip
30281-
Cell
(770) 369-1320
Family Status
Single adult
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

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
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
Carlos H. Hernandez 10/14/2000 Mother GA/USA
Dayreth C. Hernandez 10/06/2008 Mother GA/USA
Rolando A. Hernandez 02/13/2007 Mother GA/USA

Former Spouse 1 Information

Last
Hernandez
First
Jorge
DOB
03/25/1978
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/ Cepta