COR-DIA-76

Code
COR-DIA-76
Mercy ID
V-01841-01
Encounter Date
02/21/2005
Last
Cortez
First
Diana
DOB
07/06/1976
County
Cobb
Street
not given
City
Not given
State
GA
Zip
00000-
Home
(000) 000-0000
Family Status
Single parent w/children
COB
Honduras
Gender
Female
Housing
Shelter
Education Level
Other

Spouse Information

Last
Funes
First
Felipe
DOB
12/25/1971
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
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
Alejandra 12/05/1991 Mother GA/USA
Jorge 01/17/1995 Mother GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
K. Aleman
Referred By
Walk-in