SIL-ESM-75

Code
SIL-ESM-75
Mercy ID
V-02172-01
Encounter Date
02/07/2006
Last
Silva
First
Esmeralda
DOB
03/17/1975
County
Cobb
Street
1245 Brend Dr. SW
City
Marietta
State
GA
Zip
30008-
Cell
(678) 334-6660
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade school

Spouse Information

Last
Perez
First
Mauricio
DOB
05/05/1975
Address
N/A
Telephone
(404) 572-1568
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
No
Consentimiento De Participar
YES

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
Andres Perez 06/02/2010 Parents GA/USA
Leonardo Pérez 09/17/2007 Parents GA/USA
Sebastian Perez 09/21/2006 Parents GA/USA
NOTES

Media Authoritation

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