FER-EMM-64

Code
FER-EMM-64
Mercy ID
V-00750-01
Encounter Date
11/15/2001
Last
Fernandez
First
Emma
DOB
12/22/1964
County
Gwinnett
Street
2065 Ravinia Ct.
City
Lawrenceville
State
GA
Zip
30044-
Home
(770) 448-9101
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Other
Education Level
Grade 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
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
Gabriel Fernandez 06/28/1996 Parents GA/USA
Jose Jose Fernandez 02/14/1992 Parents GA/USA
Martha Carolina Sanchez 03/27/1990 Mother w/Stepfather GA/USA
Telmy Fernandez 03/27/1990 Mother w/Stepfather 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 Rebecca