CRI-CEC-81

Code
CRI-CEC-81
Mercy ID
V-02489-01
Encounter Date
05/14/2007
Last
Crisanto
First
Cecilia
DOB
08/16/1981
County
Cobb
Street
1900 South Cobb Dr. Apt. B-9
City
Marietta
State
GA
Zip
30060-
Other
(770) 882-6602
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Adult, no formal education

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
YES
Program Completed
YES
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
YES
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Brizeda Crisanto 01/05/1998 Mother GA/USA
Modesto Crisanto 12/25/2001 Mother GA/USA

Former Spouse 1 Information

Last
Caro
First
Vicente
DOB
08/12/1974
Telephone
N/A
COB
Mexico
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
J. Manzo
Referred By
Felipe