ADO-SHE-79

Code
ADO-SHE-79
Mercy ID
V-02073-01
Encounter Date
10/14/2005
Last
Adorno
First
Sheila
DOB
08/09/1979
County
Clayton
Street
1160 Rock Spring
City
Forest park
State
GA
Zip
30297-
Cell
(404) 361-5814
Family Status
Two parent family w/children
COB
Puerto Rico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Peña
First
Toni
DOB
N/A
Address
N/A
Telephone
N/A
COB
Venezuela
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
Jericob Peña 03/30/2000 Father w/Stepmother GA/USA
Ninoshka Rios 03/09/1996 Mother w/Stepfather GA/USA
Stephanie Rios 08/06/1997 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Ramires
First
Mercedes
DOB
N/A
Telephone
N/A
COB
N/A
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
R. Gonzalez
Referred By