ESQ-MON-72

Code
ESQ-MON-72
Mercy ID
V-00927-01
Encounter Date
05/20/2002
Last
Esquivel
First
Monica
DOB
05/27/1972
County
Gwinnett
Street
512 Trail Lane
City
Lawrenceville
State
GA
Zip
30345-
Cell
(770) 367-1755
Family Status
Single adult
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
H.S. equivalency diploma

Spouse Information

Last
Miranda
First
Francisco alberto
DOB
07/25/1976
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
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Monica Galicia 10/27/1988 Grandmother Canada

Former Spouse 1 Information

Last
Pimentel
First
Pedro
DOB
N/A
Telephone
N/A
COB
USA
Home Owner
YES

Former Spouse 2 Information

Last
L?????????????????????????????
First
L?????????????????????????????
DOB
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
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