VEN-SUS-73

Code
VEN-SUS-73
Mercy ID
V-00953-01
Encounter Date
05/24/2002
Last
Ventura
First
Susana
DOB
08/10/1973
County
Hall
Street
5565 Mulberry St.
City
Flowery branch
State
GA
Zip
30542-
Home
(678) 508-5842
Cell
(678) 887-2941
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
Espinoza
First
Elio
DOB
10/15/1976
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
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Angela N. Flores 08/27/2003 Mother GA/USA
Isaac Flores 09/04/1997 Mother GA/USA
Marco Antonio 06/11/2001 Mother GA/USA
Uriel Ventura 07/17/2008 Mother GA/USA

Former Spouse 1 Information

Last
Flores
First
Marcos
DOB
06/13/1976
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
YES
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
K. Aleman
Referred By
x7764 Ma. Eugenia