RIV-SAN-69

Code
RIV-SAN-69
Mercy ID
V-02002-01
Encounter Date
07/25/2005
Last
Rivera
First
Sandra
DOB
03/18/1969
County
Gwinnett
Street
3078 Arden Rich Terrace
City
Suawnee
State
GA
Zip
30024-
Family Status
Two parent family w/children
COB
Nicaragua
Gender
Female
Housing
Not Homeless
Education Level
High school graduate

Spouse Information

Last
Mairena
First
Jerald
DOB
N/A
Address
N/A
Telephone
N/A
COB
Nicaragua
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
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
Jerald Mairena 10/17/1996 Parents GA/USA
Liz Mairena 09/13/1994 Parents 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