DOR-MAR-72

Code
DOR-MAR-72
Mercy ID
V-01495-01
Encounter Date
02/20/2004
Last
Dorantes
First
Maria idalia
DOB
05/18/1972
County
Gwinnett
Street
4008 Orion Arcway
City
Norcross
State
GA
Zip
30093-
Cell
(678) 531-2845
Other
(770) 279-9768
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
College Degree

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
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
YES
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
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Dahann Vargas 07/24/1999 Mother GA/USA
Maximo Vargas 12/08/2003 Mother GA/USA
Natasha Vargas 04/12/2005 Mother GA/USA

Former Spouse 1 Information

Last
Vargas
First
Cesario
DOB
11/27/1977
Telephone
N/A
COB
Mexico
Home Owner
YES
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
x1375 Damaryz