QUI-MAR-78

Code
QUI-MAR-78
Mercy ID
V-01520-01
Encounter Date
03/10/2004
Last
Quintana
First
Martha
DOB
01/18/1978
County
Fulton
Street
1216 Wood Creek Trl.
City
Roswell
State
GA
Zip
30076-
Home
(770) 912-4040
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Rojas
First
Samuel
DOB
08/20/1982
Address
Died in a car wreck
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
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
Daniel Quintana 02/26/2001 Mother GA/USA
Freddy Quintana 08/06/1997 Mother GA/USA
Jonathan Quintana 05/31/2002 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
Walk in/amiga