CEJ-YAN-82

Code
CEJ-YAN-82
Mercy ID
V-01918-01
Encounter Date
06/27/2005
Last
Ceja
First
Yanin
DOB
11/26/1982
County
Fulton
Street
811 Park Ridge Lane Apt. D
City
Roswell
State
GA
Zip
30076-
Cell
(678) 851-6164
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
Garcia
First
Saul
DOB
10/21/1989
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
YES
Relative
YES
Stranger
No
As An Adult
YES
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Angel Eduardo Martinez 08/08/2003 Parents GA/USA
Fernanda Martinez 05/19/2002 Parents GA/USA

Former Spouse 1 Information

Last
Martinez
First
Eduardo
DOB
05/21/1977
Telephone
(404) 454-2499
COB
Mexico
Home Owner
No
NOTES

Media Authoritation

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