QUI-AMA-65

Code
QUI-AMA-65
Mercy ID
V-01009-01
Encounter Date
09/05/2002
Last
Quintero
First
Amalia
DOB
12/25/1965
County
Cowetta
Street
412 Old Carrollton Rd.
City
Newman
State
GA
Zip
30263-
Home
(678) 423-0770
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Quintero
First
Juan
DOB
06/08/1965
Address
N/A
Telephone
N/A
COB
Mexico
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
No
Consentimiento De Participar
No

Petitioner

TPO
No
Stay Away Condition
No
Mutual
No

Defendant

TPO
No
Stay Away Condition
No
Mutual
No
Driver
No
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
Francisco Richard 09/26/1988 Parents GA/USA
Jenifer 08/10/2000 Parents GA/USA
Jessica 08/10/2000 Parents GA/USA
Juan Antonio 02/13/1986 Parents GA/USA
Maria Eugenia 05/06/1987 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
Casa San Jose