QUI-MAR-65

Code
QUI-MAR-65
Mercy ID
V-00053-01
Encounter Date
01/03/2000
Last
Quiroz
First
Maria
DOB
04/30/1965
County
Cobb
Street
105 Etheretge Rd
City
Temple
State
GA
Zip
30179-
Home
(770) 562-0112
Family Status
Single adult
COB
Costa Rica
Gender
Female
Housing
Not Homeless
Education Level
College Degree

Spouse Information

Last
Bertalioni
First
Rafael
DOB
10/26/1951
Address
N/A
Telephone
N/A
COB
Costa Rica
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
No
Consentimiento De Participar
No

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
chiara bertalioni 02/11/1994 Mother GA/USA
indira bertalioni 12/20/1990 Mother GA/USA
maria daniela quiros 12/10/1989 Mother GA/USA
paola bertalioni 03/03/1996 Mother GA/USA
sofia bertalioni 12/10/1998 Mother 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
D. Gomez
Referred By