CER-MAR-70

Code
CER-MAR-70
Mercy ID
V-00257-01
Encounter Date
07/27/2000
Last
Cervantes
First
Mariana
DOB
08/19/1970
County
Dekalb
Street
4727 Buford Hwy Apt H
City
Chamblee
State
GA
Zip
30341-
Home
(404) 297-5753
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Shelter
Education Level
some high school

Spouse Information

Last
Olvera
First
Hector
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
Alejandra Beronica Gonzalez 02/10/1994 Grandparents GA/USA
Roberto Miguel Perez 05/06/2000 Parents GA/USA
Zaida Mariana Gonzalez 11/28/1990 Grandparents GA/USA

Former Spouse 1 Information

Last
Perez
First
Miguel
DOB
02/13/1968
Telephone
N/A
COB
N/A
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
D. Gomez
Referred By
Rebeca-7764