BER-VAN-72

Code
BER-VAN-72
Mercy ID
V-00873-01
Encounter Date
03/23/2002
Last
Bermudez
First
Vanessa
DOB
03/29/1972
County
Gwinnett
Street
0000 Not Given
City
Lawrenceville
State
GA
Zip
00000-000
Home
(770) 277-9214
Family Status
Single parent w/children
COB
Costa Rica
Gender
Female
Housing
Not Homeless
Education Level
College Degree

Spouse Information

Last
Duarte
First
Carlos
DOB
10/23/1974
Address
N/A
Telephone
N/A
COB
Costa Rica
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
YES
Relative
YES
Stranger
No
As An Adult
YES
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Carlos 05/23/2000 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
K. Aleman
Referred By
DRCC xLyrna