POL-DOR-65

Code
POL-DOR-65
Mercy ID
V-02152-01
Encounter Date
01/23/2006
Last
Polanco
First
Dora
DOB
11/26/1965
County
Gwinnett
Street
1796 Ridge Dale dr
City
Snellville
State
GA
Zip
30078-
Home
(770) 972-5392
Cell
(404) 488-4317
Family Status
Two parent family w/children
COB
Costa Rica
Gender
Female
Housing
Not Homeless
Education Level
High school graduate

Spouse Information

Last
Polanco
First
Modesto
DOB
N/A
Address
N/A
Telephone
N/A
COB
USA
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
Antony Polanco 10/05/2002 Parents GA/USA
Daniel Polanco 08/22/2005 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