CRU-MAR-65

Code
CRU-MAR-65
Mercy ID
V-01942-01
Encounter Date
06/20/2005
Last
Cruz
First
Martha
DOB
08/24/1965
County
Gwinnett
Street
4262 Pleasant Lake Village Lane Apt A
City
Duluth
State
GA
Zip
30096-
Home
(770) 497-9574
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Cruz
First
Javier
DOB
07/02/1964
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
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
David Cruz 10/16/1994 Mother GA/USA
Jaime Cruz 03/24/1985 Mother GA/USA
Javier Cruz 09/21/1988 Mother GA/USA
Jesus Cruz 05/23/1987 Mother GA/USA
Ricardo Cruz 05/23/1983 Mother GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
K. Aleman
Referred By