VAL-IRI-75

Code
VAL-IRI-75
Mercy ID
V-02315-01
Encounter Date
08/09/2006
Last
Valentin
First
Iris
DOB
06/04/1975
County
Gwinnett
Street
4018 Centenal Trial
City
Duluth
State
GA
Zip
30096-
Cell
(678) 492-9892
Family Status
Two parent family w/children
COB
Puerto Rico
Gender
Female
Housing
Doubling Up
Education Level
College Degree

Spouse Information

Last
Collazo
First
Hector
DOB
N/A
Address
N/A
Telephone
N/A
COB
Puerto Rico
Home Owner
YES
Driver
No
Home Owner
YES
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
Francisco Mendoza 02/28/2000 Mother GA/USA
Syrena Barriela 03/08/2005 Mother GA/USA

Former Spouse 1 Information

Last
Barriela
First
Charlie
DOB
N/A
Telephone
N/A
COB
N/A
Home Owner
YES

Former Spouse 2 Information

Last
L?????????????????????????????
First
L?????????????????????????????
DOB
N/A
Telephone
N/A
COB
Puerto Rico
Home Owner
YES
NOTES

Media Authoritation

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