VER-MAR-81

Code
VER-MAR-81
Mercy ID
V-02124-01
Encounter Date
12/20/2005
Last
Vergara
First
Martha
DOB
08/25/1981
County
Dekalb
Street
3504 Chamblee Dunwoody Way
City
Chamblee
State
GA
Zip
30341-
Home
(404) 816-7320
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Gama
First
Esteban
DOB
12/05/1973
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
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
Juan Manuel Gama 12/09/2005 Parents GA/USA
Maria Joana Gama 03/08/2000 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
R. Gonzalez
Referred By
Felipe Perez