ZAR-JES-77

Code
ZAR-JES-77
Mercy ID
V-01464-01
Encounter Date
01/14/2004
Last
Zarco
First
Jessica
DOB
03/07/1977
County
Gwinnett
Street
6310 Forest Valley Dr #2
City
Norcross
State
GA
Zip
30093-
Home
(678) 558-6205
Cell
(678) 558-6205
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Leyva
First
Jorge
DOB
N/A
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
YES
Alcohol & Drug
No
Partner Referred to Tepestri
No
Recidivism/Court
No
New Incident
No
Promesa de Confidencialidad
YES
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
Brayan Reyes 11/26/1993 N/A Mexico
Irvin Incinar 06/24/2002 N/A GA/USA
Kevin Incinar 03/12/1999 N/A Mexico

Former Spouse 1 Information

Last
Incinal
First
Angel
DOB
N/A
Telephone
N/A
COB
N/A
Home Owner
No
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