COR-ADR-64

Code
COR-ADR-64
Mercy ID
V-00349-01
Encounter Date
01/13/2003
Last
Correa
First
Adriana
DOB
08/31/1964
County
Gwinnett
Street
2560 Wildflower Ln.
City
Lawrenceville
State
GA
Zip
30044-
Home
(678) 376-9146
Cell
(770) 940-1419
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
High school graduate

Spouse Information

Last
Martin
First
Octavio
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
YES
Consentimiento De Participar
YES

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
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Braulio Cesar 06/21/1994 Parents GA/USA
Luz Elena Marin 05/11/1990 Parents GA/USA
Miguel Adrian 09/28/2000 Parents GA/USA
Oscar Octavio Marin 08/01/1987 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
K. Aleman
Referred By
x3737 Damariz