LIZ-FRA-78

Code
LIZ-FRA-78
Mercy ID
V-03500-01
Encounter Date
01/13/2011
Last
Lizana
First
Francisca
DOB
11/20/1978
County
Gwinnett
Street
1086 William Brunch Lane
City
Norcross
State
GA
Zip
30093-
Cell
(678) 353-1605
Family Status
Single parent w/children
COB
El Salvador
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
Mexico
Home Owner
No
Driver
No
Home Owner
YES
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
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
Donovan Portillo 10/04/2002 Mother GA/USA
Jennifer Portillo 11/07/2000 Mother GA/USA

Former Spouse 1 Information

Last
Torres
First
Angel
DOB
04/29/1985
Telephone
N/A
COB
Puerto Rico
Home Owner
YES
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
linea-Juana