MER-CAR-69

Code
MER-CAR-69
Mercy ID
V-03519-01
Encounter Date
01/31/2011
Last
Mercado
First
Carmen
DOB
07/19/1969
County
Gwinnett
Street
5855 Hammond Drive
City
Norcross
State
GA
Zip
30071-
Cell
(678) 508-1380
Family Status
Single parent w/children
COB
Argentina
Gender
Female
Housing
Single Family
Education Level
High school graduate

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
Alan Miños 12/03/2003 Mother GA/USA
Brian Miñoz 02/25/1999 Mother GA/USA

Former Spouse 1 Information

Last
Muñoz
First
Norberto
DOB
N/A
Telephone
N/A
COB
Argentina
Home Owner
No
NOTES
Norbertoesta deportado

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