CON-VER-81

Code
CON-VER-81
Mercy ID
V-02643-01
Encounter Date
11/13/2007
Last
Contreras
First
Veronica
DOB
06/29/1981
County
Cowetta
Street
999 no la dio
City
Newman
State
GA
Zip
99999-9999
Cell
(678) 252-7484
Other
(678) 304-0966
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Shelter
Education Level
Grade school

Spouse Information

Last
Sanchez
First
Juan
DOB
N/A
Address
N/A
Telephone
N/A
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
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
Alexander Contreras 03/11/2000 Mother GA/USA
Maria Lizbeth Contreras 10/04/2007 Mother GA/USA
Ruben Contreras 02/20/1998 Aunt Mexico
Yuliana Cordero 07/27/2003 Mother GA/USA
NOTES
Tia materna

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
linea-Juana