ARE-SUS-89

Code
ARE-SUS-89
Mercy ID
O-00002-01
Encounter Date
03/22/2010
Last
Arellano
First
Susana
DOB
05/03/1989
County
Gwinnett
Street
999 No quiso dar
City
Norcross
State
GA
Zip
30340-
Cell
(404) 484-4294
Family Status
Single parent w/children
COB
USA
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
YES
Consentimiento De Participar
YES

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
Jonathan Cisneros 06/25/2008 Mother GA/USA

Former Spouse 1 Information

Last
Cisneros
First
Sergio
DOB
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES

Media Authoritation

DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
Entrevista-Jacqueline