ESC-BER-67

Code
ESC-BER-67
Mercy ID
V-01211-01
Encounter Date
04/30/2003
Last
Escorcia
First
Bertha
DOB
04/06/1967
County
Dekalb
Street
1600 Winter Creek Dr. Apt. 401
City
Doraville
State
GA
Zip
30360-
Home
(770) 447-6973
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Moreno
First
Raymundo
DOB
03/15/1972
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
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Erika Gutierrez 05/31/1986 Father California
Ivan Gutierrez 05/04/1987 Father California
Yaremi Gutierrez 01/14/1989 Father California
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
x3737 Damaryz