TRE-PAT-65

Code
TRE-PAT-65
Mercy ID
V-03529-01
Encounter Date
02/15/2011
Last
Treblay
First
Patricia
DOB
03/17/1965
County
Gwinnett
Street
7035 Bavarian Wood Place
City
Buford
State
GA
Zip
30519-
Cell
(678) 887-1552
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
College Degree

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
Hasive Treblay 07/31/1991 Mother GA/USA
Jahazil Treblay 03/21/1990 Mother GA/USA
Jeriel Treblay 04/05/2005 Mother GA/USA

Former Spouse 1 Information

Last
Treblay
First
Carl
DOB
02/13/1966
Telephone
N/A
COB
Canadq
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