SIL-FLO-69

Code
SIL-FLO-69
Mercy ID
V-02962-01
Encounter Date
11/26/2008
Last
Silverio
First
Florinda
DOB
01/18/1969
County
Fulton
Street
166 Holcom ferry Apt. # 1302
City
Roswell
State
GA
Zip
30076-
Cell
(404) 454-4271
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
YES
Program Completed
No
DFCS Mandated
No
Alcohol & Drug
No
Partner Referred to Tepestri
No
Recidivism/Court
No
New Incident
No
Promesa de Confidencialidad
YES
Consentimiento De Participar
YES

Petitioner

TPO
No
Stay Away Condition
No
Mutual
No

Defendant

TPO
No
Stay Away Condition
YES
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
Jose M. Velazquez 06/16/2003 Mother GA/USA
Michell Velazquez 01/05/2002 Mother GA/USA

Former Spouse 1 Information

Last
Velazquez
First
Amado
DOB
07/09/1962
Telephone
N/A
COB
N/A
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
Linea-Griselda/Fulton Cty