CON-HIL-65

Code
CON-HIL-65
Mercy ID
V-01028-01
Encounter Date
11/07/2002
Last
Contreras
First
Hilda
DOB
10/22/1965
County
Gwinnett
Street
1897 Fellowship Apt. B
City
Tucker
State
GA
Zip
30084-
Home
(404) 417-9851
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up

Spouse Information

Last
Lopez
First
Victor
DOB
11/13/1975
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
YES
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
Alaine Cruz 12/18/1980 Adulto/Casado GA/USA
Avaiser Cruz 11/18/1981 Mother 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
court