BRO-MAR-71

Code
BRO-MAR-71
Mercy ID
V-01011-01
Encounter Date
09/09/2002
Last
Brocks
First
Maria eugenia
DOB
07/22/1971
County
Fulton
Street
791 Riverdale Dr.
City
Jonesboro
State
GA
Zip
30238-
Home
(770) 719-8748
Family Status
Two parent family w/children
COB
Venezuela
Gender
Female
Housing
Not Homeless
Education Level
some high school

Spouse Information

Last
Brocks
First
Alex
DOB
03/17/1973
Address
N/A
Telephone
N/A
COB
Venezuela
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
Jorge Brocks 09/22/1993 Parents GA/USA
Nataly Brocks 10/18/1999 Parents 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 Ma. Eugenia