CRU-MAI-69

Code
CRU-MAI-69
Mercy ID
V-02591-01
Encounter Date
09/27/2007
Last
Cruz
First
Maria
DOB
06/30/1969
County
Rockdale
Street
1230 Mill Crest Walk
City
Conyers
State
GA
Zip
30012-
Home
(770) 648-7379
Cell
(404) 642-4284
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
High school graduate

Spouse Information

Last
Rendon
First
Gabriel
DOB
02/06/1974
Address
N/A
Telephone
N/A
COB
Mexico
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
YES
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
Alan Gabriel Rendon 04/02/1995 Parents GA/USA
Karla Rendon 05/09/1997 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
J. Manzo
Referred By
linea-Juana