VIL-IRM-65

Code
VIL-IRM-65
Mercy ID
V-00436-01
Encounter Date
02/28/2001
Last
Villa
First
Irma
DOB
10/17/1965
County
Gwinnett
Street
3991 Centenial Trl.
City
Duluth
State
GA
Zip
30096-
Home
(678) 580-5905
Cell
(770) 246-9915
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
Quesada
First
Jose antonio
DOB
05/14/1962
Address
N/A
Telephone
N/A
COB
Dominican Rep
Home Owner
YES
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
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Alejandro Villa 06/30/1989 Mother w/Stepfather GA/USA
Ana Delia Quesada 10/03/1996 Parents GA/USA
Jennifer Quesada 05/09/2000 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
x7764 Mitchell